Clinics in Orthopedic Surgery最新文献

{"title":"Similar Outcomes after Cyst Decompression with Biceps Tenodesis Versus Cyst Decompression with Repair of Superior Labrum Anterior to Posterior Lesions in Patients with Paralabral Cysts.","authors":"Chul-Hyun Cho, Ji-Hoon Kim, Du-Han Kim","doi":"10.4055/cios25351","DOIUrl":"10.4055/cios25351","url":null,"abstract":"<p><strong>Background: </strong>Superior labrum anterior to posterior (SLAP) lesions with paralabral cysts are uncommon. Although various procedures have been suggested, there is no consensus on the optimal choice. The purpose of this study was to compare clinical and radiological results between 2 procedures: SLAP repair with cyst decompression (RD group) and subpectoral biceps tenodesis with cyst decompression (TD group).</p><p><strong>Methods: </strong>Arthroscopic surgery for management of a paralabral cyst with a SLAP lesion was performed from January 2009 to January 2023 in 42 patients (RD group: 17, TD group: 25), who were available for a minimum 12-month follow-up. The visual analog scale (VAS) pain score, University of California, Los Angeles (UCLA) score, activities of daily living (ADL) score, and Subjective Shoulder Value (SSV) were evaluated. Postoperative magnetic resonance imaging (MRI) and manual muscle testing (MMT) were performed 6 months after surgery.</p><p><strong>Results: </strong>The mean age of patients in the RD group was 40.0 years and that of the TD group was 46.4 years (<i>p</i> = 0.014). Both groups showed significant improvement in the VAS pain score, UCLA score, ADL score, SSV score, and MMT after surgery. However, no significant difference was observed between the 2 groups. All but 1 patient in the RD group were able to return to work and sports at preoperative levels. This patient was diagnosed with brachial plexopathy after surgery and showed spontaneous improvement. Twenty-five of 42 patients (59.5%) underwent follow-up MRI 6 months after surgery, and there was no recurrence of the ganglion cyst with complete resorption.</p><p><strong>Conclusions: </strong>Compared with cyst decompression and SLAP repair, cyst decompression combined with subpectoral biceps tenodesis demonstrated no statistically significant differences in clinical and radiographic outcomes in this retrospective cohort of patients with SLAP lesions and concomitant paralabral cysts. The findings of our study suggest that biceps tenodesis may be an effective surgical alternative for patients with compromised biceps integrity.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"687-694"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674417","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":"A Reliable Prediction Method for the Pedicle Subtraction Osteotomy Angle in Ankylosing Spondylitis-Related Thoracolumbar Kyphosis: A Comparative Analysis with Existing Approaches.","authors":"Mu Qiao, Bang-Ping Qian, Kai-Yang Wang, Chen-Yu Song, Jing-Shun Lu, Yong Qiu","doi":"10.4055/cios25104","DOIUrl":"10.4055/cios25104","url":null,"abstract":"<p><strong>Background: </strong>Careful preoperative planning regarding the reliable angle of pedicle subtraction osteotomy (PSO) in ankylosing spondylitis (AS) is beneficial for sagittal realignment, preventing undercorrection or overcorrection, and mitigating potential mechanical complications. The purpose of this study was to propose a novel method, using AS-specific realignment criteria and Surgimap software, for calculating a reliable PSO angle in AS patients with thoracolumbar kyphosis, and to compare its predictive accuracy with 3 other methods reported in the previous literature.</p><p><strong>Methods: </strong>Sixty-one AS patients who underwent 1-level PSO were analyzed, fulfilling the ideal sagittal balance criteria of adult spinal deformity at the final follow-up: pelvic tilt (PT) < 25°, sagittal vertical axis (SVA) < 50 mm, and -10° < pelvic incidence minus lumbar lordosis (PI-LL) < 10°. In the new method, the formula PT = (0.47 × PI - 7.5) was used to target reliable postoperative PT. Besides, AS-specific realignment criteria for surgical planning were as follows: PT < 24°, Spinosacral angle (SSA) > 108°, T1 pelvic angle (TPA) < 22°, and spinopelvic angle (SPA) > 152°. All the 4 methods were applied to calculate the theoretical angle of osteotomy (tAO) for each patient, including the trigonometric method, full balance integrated (FBI), SS-based ASKyphoplan, and Surgimap Spine plan. The difference between pre- and postoperative osteotomized vertebral angle in radiographs was defined as the actual angle of osteotomy (aAO). Precision of all predictive methods was evaluated on the basis of concordance correlation coefficient (CCC), accuracy rate, root mean squared prediction error (RMSE), and difference between tAO and aAO (bias).</p><p><strong>Results: </strong>Significant improvement in global kyphosis, LL, and SVA were noted postoperatively for all 61 patients without obvious correction loss at the final follow-up. The most accurate and precise method for the osteotomy angle calculation was the AS Surgimap plan (prediction accuracy, 72.13%; bias, -2.36%; RMSE, 8.34; CCC, 0.837), followed by FBI, the trigonometric method, and ASKyphoplan. The prediction accuracy, undercorrection rate, and overcorrection rate for the low and high PI groups were 80.00%, 5.71%, and 14.29% and 61.54%, 30.77%, and 7.69%, respectively.</p><p><strong>Conclusions: </strong>Surgimap Spine plan was relatively the most reliable and accurate approach to predict the PSO angle and achieve proper postoperative sagittal alignment for AS patients in comparison to other methods. Predetermined PT using the equation PT = (0.47 × PI - 7.5) and well-defined criteria (SSA > 108°, SPA > 152°, and TPA < 22°) could improve the predictive values.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"474-484"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144712","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":"Accuracy of the Schöttle Technique for Femoral Medial Patellofemoral Ligament Footprint Localization in Trochlear Dysplasia: A Fluoroscopic Case-Control Study on 3-Dimensional-Printed Femurs.","authors":"Yusuf Cakir, Ozkan Kose, Huseyin Kursat Celik, Hakan Cetin, Mehmet Baris Ertan","doi":"10.4055/cios25276","DOIUrl":"10.4055/cios25276","url":null,"abstract":"<p><strong>Background: </strong>The objective of this experimental study was to assess the accuracy of the Schöttle technique in localizing the femoral footprint of the medial patellofemoral ligament (MPFL) in femora with and without trochlear dysplasia, utilizing 3-dimensional (3D)-printed bone models and standardized fluoroscopic imaging. It was hypothesized that trochlear dysplasia, particularly in its more severe forms, would negatively influence the accuracy of this radiographic method.</p><p><strong>Methods: </strong>A total of forty-four 3D-printed femoral models, generated from computed tomography scans of patients with trochlear dysplasia (n = 21) and those with normal trochlear morphology (n = 23), were included in the analysis. The anatomic MPFL insertion was defined using the saddle sulcus and marked with a radiopaque reference. True lateral knee fluoroscopic images were obtained, and the Schöttle point was identified using standard radiographic criteria. The distance between the Schöttle point and the anatomic footprint was measured. Deviations > 5 mm and > 7 mm were defined as clinically unacceptable. Subgroup analysis was performed according to Dejour classification.</p><p><strong>Results: </strong>The mean distance between the Schöttle point and the anatomic footprint was 4.4 ± 2.0 mm in the dysplasia group and 4.2 ± 2.4 mm in the control group (<i>p</i> = 0.862). The proportion of clinically acceptable placements did not differ significantly at the 5 mm (66.7% vs. 60.9%, <i>p</i> = 0.467) or 7 mm (85.7% vs. 82.6%, <i>p</i> = 0.553) thresholds. Accuracy was also similar across dysplasia grades (<i>p</i> = 0.477).</p><p><strong>Conclusions: </strong>In this experimental modeling study, the Schöttle technique demonstrated similar average accuracy in localizing the femoral MPFL footprint in femora with and without trochlear dysplasia. However, clinically relevant deviations greater than 5 mm were observed in approximately one-third of cases, regardless of trochlear morphology. The Schöttle technique may serve as an intraoperative estimate rather than a definitive target, pending in-vivo validation. Surgeons should be cautious and consider complementary methods to optimize femoral tunnel placement.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"461-473"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144689","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 Outcomes of Straddle Fracture Patterns: A Retrospective Multicenter Analysis Based on a New Descriptive Classification Framework.","authors":"Yong-Cheol Yoon, Hyung Keun Song, Dong Sub Im, Hyoung-Keun Oh, Min Jun Kim","doi":"10.4055/cios25229","DOIUrl":"10.4055/cios25229","url":null,"abstract":"<p><strong>Background: </strong>Straddle fractures involving bilateral pubic rami are complex pelvic ring injuries resulting from high-energy trauma. Existing classifications primarily focus on posterior ring injuries, often overlooking the anterior ring's contribution to pelvic instability. This study aimed to describe and analyze straddle fracture patterns and their associated clinical outcomes using a newly proposed framework that integrates both anterior and posterior pelvic ring components.</p><p><strong>Methods: </strong>A retrospective multicenter cohort study was conducted involving 203 patients treated for straddle fractures at 3 level I trauma centers between March 2015 and December 2021. Fractures were categorized into 3 grades according to anterior and posterior ring involvement, ramus displacement, and pelvic instability. Management strategies ranged from conservative care to combined anterior-posterior fixation. Radiological and functional outcomes were assessed, and logistic regression analysis identified factors associated with complications. Reliability was evaluated using kappa statistics.</p><p><strong>Results: </strong>Treatment strategies showed high concordance with the proposed framework (86%, 90%, and 88% for grades I, II, and III, respectively). Interobserver (Fleiss' κ = 0.65) and intraobserver (Cohen's kappa = 0.73) reliability demonstrated substantial agreement. Anatomic reduction (≤ 4 mm displacement) was achieved in 78.7%, 55.7%, and 45.5% of grades I-III, respectively (<i>p</i> = 0.009). Complication rates increased with grade severity (6.4%, 13.9%, and 22.1%; <i>p</i> = 0.057). Age (odds ratio [OR], 1.049; <i>p</i> = 0.006), Injury Severity Score (OR, 1.113; <i>p</i> < 0.001), and fracture grade independently predicted complications.</p><p><strong>Conclusions: </strong>This new descriptive classification framework provides a reproducible and clinically relevant method for stratifying straddle fracture severity and prognosis. While not intended as a prescriptive treatment algorithm, it demonstrates strong reliability and meaningful correlations between grade, radiological alignment, and complication risk. Higher-grade fractures were associated with greater instability and poorer outcomes, underscoring the importance of individualized management strategies and the need for future prospective and biomechanical validation.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"393-404"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144859","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 Surgical Treatment of Femoral Head Fractures with a Minimum of 1-Year Follow-up.","authors":"Hyun-Chul Shon, Eic-Ju Lim, Kook-Jong Kim, Jae-Young Yang","doi":"10.4055/cios25437","DOIUrl":"10.4055/cios25437","url":null,"abstract":"<p><strong>Background: </strong>Femoral head fractures are uncommon injuries, usually resulting from high-energy trauma and often accompanied by other musculoskeletal injuries, which complicate management. Despite advancements in surgical techniques, complications such as posttraumatic osteoarthritis (OA) and heterotopic ossification (HO) remain prevalent, and no standardized treatment protocol has been established. Furthermore, most existing reports are small-scale or multi-center studies with heterogeneous management. The aim of this study was to evaluate the radiological and functional outcomes, as well as complications, of surgically treated femoral head fractures managed by a single surgeon at a single center with a minimum of 1-year follow-up.</p><p><strong>Methods: </strong>This retrospective study included 48 patients who underwent surgery for femoral head fractures between January 2007 and December 2023. Demographic characteristics, injury mechanisms, associated injuries, surgical methods, conversion to total hip arthroplasty, and complications were obtained from medical records. Fractures were classified using the Pipkin system based on preoperative radiographs and 3-dimensional computed tomography. Postoperative evaluations included radiological assessment for OA, avascular necrosis, and HO, and functional assessments using the modified Postel-Merle d'Aubigné score and Thompson and Epstein clinical criteria. Final outcomes were analyzed according to Pipkin fracture type and surgical approach.</p><p><strong>Results: </strong>The rate of excellent or good outcomes was higher in Pipkin types I and II than in type IV according to both the Thompson-Epstein roentgenographic (100%, 100%, and 58.3%) and clinical (90%, 90.9%, and 54.2%) criteria. Merle d'Aubigné-Postel scores were also higher in Pipkin types I (16.4) and II (16.8) than in type IV (15.0). Posttraumatic OA was most frequent in the flip osteotomy group (75%) and in Pipkin type IV fractures (60%). HO occurred most commonly with the anterior and flip osteotomy approaches (33.3%) and in Pipkin type I fractures (40.0%).</p><p><strong>Conclusions: </strong>Femoral head fractures remain uncommon injuries often associated with concomitant trauma and a high incidence of complications. We demonstrated favorable radiological and functional outcomes following surgical treatment, with results analyzed according to Pipkin type and surgical approach. These findings offer clinically meaningful insights that may advance ongoing research on femoral head fractures.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"420-429"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144972","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":"New Measurement Method for Lateral Acromial Protrusion as an Alternative to Critical Shoulder Angle, Independent of Sagittal Glenoid Tilt.","authors":"Do Hoon Kim, Hyeon Jang Jeong, Sungjae Bae, Yoo-Sun Won, Seok Won Lee, Sheng Chen Han, Dongho Lee, Joo Han Oh","doi":"10.4055/cios25184","DOIUrl":"10.4055/cios25184","url":null,"abstract":"<p><strong>Background: </strong>Despite the widespread use of the critical shoulder angle (CSA) for assessing lateral acromial protrusion, its reliability and consistency remain debatable. Moreover, significant CSA differences were often observed between shoulders in the same patient, even in the absence of severe bony deformity. Therefore, this study aimed to evaluate the reliability of the CSA across different imaging methods and points of view, and to propose and validate a new measurement method, the acromial protrusion ratio (APR), as a potential alternative for assessing lateral acromial protrusion by complementing the limited reliability of the CSA.</p><p><strong>Methods: </strong>This study was conducted in 2 phases: an exploratory phase evaluating the reliability of the CSA and APR and a validation phase assessing their clinical applicability. We retrospectively reviewed 25 patients who underwent reverse total shoulder arthroplasty with a CSA difference > 5° between the shoulders in the exploratory phase and prospectively collected data from 38 shoulders in the validation phase. Measurements were independently performed by 2 assessors using different imaging methods (plain radiography and 3-dimensional [3D] reconstructed computed tomography) and points of view at the measurement (orthogonal [3DO] and neutral [3DN] scapular positions). Inter- and intraclass correlations were calculated to assess the reliability of the measurements.</p><p><strong>Results: </strong>CSA measurements showed significant differences between the shoulders on plain radiographs (<i>p</i> < 0.001) and 3DN views (<i>p</i> < 0.001), but not on 3DO views (<i>p</i> = 0.547). In contrast, the APR showed no significant differences between shoulders or across different measurement methods (all <i>p</i> > 0.05). The APR was calculated using the following formula based on the CSA at the 3DO position: APR (%) = [CSA (°) × 0.007 + 0.053] × 100.</p><p><strong>Conclusions: </strong>The CSA differed according to the measurement method and scapular tilt, even in an optimized true anteroposterior view. In contrast, the APR was consistent regardless of the measurement method and scapular tilt. Therefore, the APR may serve as a reliable alternative for assessing lateral acromial protrusion to complement the weak reliability of the CSA. However, its clinical relevance should be further validated in future studies.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"498-506"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145020","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":"Weight-Bearing Test: A Straightforward and Reliable Indicator of Stability in Supination-External Rotation Type, Weber B Ankle Fractures.","authors":"Minkyu Seo, Minsung Kwon, Ki-Sun Sung","doi":"10.4055/cios25349","DOIUrl":"10.4055/cios25349","url":null,"abstract":"<p><strong>Background: </strong>Surgical indications of supination-external rotation type, Weber B (SER/Weber B) ankle fractures seem to be well defined according to the stability of the mortise. However, in some SER type lateral malleolar fractures with suspicious medial clear space widening, it is not easy to determine their stability. Clinical signs and other tests have been proposed to differentiate the stability of those fractures; however, these methods seem to have major concerns and limitations. Therefore, we adopted the weight-bearing (WB) test as a simple and predictable test and report the outcomes of the SER/Weber B type lateral malleolar fractures treated nonoperatively based on the WB test.</p><p><strong>Methods: </strong>In patients with SER/Weber B lateral malleolar fractures without a definite sign of medial clear space widening, the WB test was performed to assess fracture stability. If the patients with SER type lateral malleolar fractures were able to stand and walk at least 4 steps without any walking aid, fractures were considered stable and nonoperative treatment was selected. Seventy-nine Weber B lateral malleolar fractures were managed nonoperatively. Among them, 68 patients were followed up for more than 6 months. Radiographic parameters, the visual analog scale (VAS) pain score, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were evaluated and analyzed.</p><p><strong>Results: </strong>Radiographic union was achieved in all 68 patients for whom the congruency of the joint was maintained through the last follow-up without any problems. The average VAS score was 1.03 (range, 0-5) and the mean AOFAS score was 87.34 (range, 58-100). All patients returned to their pre-injury level of daily activities.</p><p><strong>Conclusions: </strong>Based on these good radiographic and clinical outcomes, the WB test appears to be a simple and reliable clinical indicator for identifying stable SER/Weber B type lateral malleolar fractures that can be managed nonoperatively.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"543-547"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145033","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":"Quantitative Analysis of the Radial Nerve Pathway Relative to the Humerus Shaft Length: A Cadaveric Study Aimed at Minimizing Nerve Injury in Fracture Treatment.","authors":"Chang-Jin Yon, Beom-Soo Kim, Eun-Seok Son, Chul-Hyun Cho","doi":"10.4055/cios25016","DOIUrl":"10.4055/cios25016","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to provide a detailed anatomical mapping of the radial nerve's course relative to the humerus and to propose a length-normalized, ratio-based posterior \"safe zone\" for dual plate fixation in distal shaft fractures to reduce the risk of iatrogenic radial nerve injury.</p><p><strong>Methods: </strong>We dissected 42 upper arms from 21 embalmed adult cadavers (mean age, 74.1 years) and measured the radial nerve in relation to key humeral landmarks from the posterior aspect. Two orthopedic surgeons performed 2 trials each, and intra- and interobserver reliability were high with Cronbach's alpha values of 0.813 and 0.910, respectively. A posterior safe zone for dual plate fixation using an 8-hole 3.5 locking compression plate (LCP) medially and a 7-hole LCP laterally with at least 2 screws per side was defined by expressing fracture location as proportions of humeral length relative to established landmarks.</p><p><strong>Results: </strong>The radial nerve entered the medial humerus at 40.5% and exited laterally at 57.0% of humeral length measured from the proximal end. Key absolute measurements were as follows: proximal humerus to the upper margin of the radial groove, 101.4 mm (range, 58-134 mm); groove length, 43.8 mm (range, 14-72 mm); upper margin of the groove to the olecranon fossa, 127.3 mm (range, 118-159 mm). Expressed as proportions, the posterior safe zone for dual plating spanned 49.1%-76.8% on the posteromedial aspect and 65.5%-88.9% on the posterolateral aspect of the proximal-to-lateral-epicondyle distance, corresponding to 115.3-180.4 mm and 153.7-208.8 mm, respectively, based on the mean humeral length.</p><p><strong>Conclusions: </strong>This cadaveric study proposes a length-normalized posterior safe zone for dual plating in distal humerus fractures. These anatomical guidelines may assist preoperative planning to avoid radial nerve injury, but clinical validation is required.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"405-412"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144956","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":"Midterm Outcomes of 3-Component Mobile-Bearing Total Ankle Arthroplasty in 124 Ankles: Influence of Preoperative Varus, Valgus, and Neutral Alignment.","authors":"Jung-Won Lim, Woo Sub Kim, Je-Min Im, Hong-Geun Jung","doi":"10.4055/cios25446","DOIUrl":"10.4055/cios25446","url":null,"abstract":"<p><strong>Background: </strong>The influence of preoperative coronal alignment on outcomes after total ankle arthroplasty (TAA) remains controversial, particularly in the presence of varus or valgus deformity. This study aimed to evaluate midterm clinical and radiographic outcomes of Salto mobile-bearing TAA according to preoperative varus, neutral, and valgus alignment.</p><p><strong>Methods: </strong>This retrospective single-center study reviewed 124 ankles that underwent primary TAA between 2014 and 2021 and were followed up for a minimum of 2 years. Ankles were classified into varus, neutral, and valgus groups based on predefined radiographic criteria. Clinical and radiographic outcomes, as well as implant survivorship, were evaluated. Adjunctive corrective procedures were performed as indicated to address associated deformities.</p><p><strong>Results: </strong>Final clinical outcomes, including American Orthopaedic Foot and Ankle Society scores, visual analog scale pain scores, and ankle range of motion, did not differ significantly among alignment groups. Most radiographic parameters improved postoperatively; however, ankles with preoperative varus alignment demonstrated greater residual hindfoot varus. Kaplan-Meier analysis demonstrated favorable midterm revision-free and reoperation-free survivorship.</p><p><strong>Conclusions: </strong>TAA can achieve favorable midterm clinical outcomes across a spectrum of preoperative coronal alignment patterns when combined with appropriate adjunctive corrective procedures. Varus deformity, including more severe forms, often requires additional correction; however, when appropriately addressed, clinical outcomes are likely to be maintained. Given the limited number of valgus ankles and the midterm follow-up duration, cautious interpretation is warranted, and further studies are needed to clarify long-term outcomes.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"558-570"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144993","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":"Anterior Cortical Reference Technique for Sagittal Positioning of Distal Femoral Resection in Kinematic Alignment Total Knee Arthroplasty.","authors":"Takafumi Hiranaka, Yasuhiro Fukai, Hirofumi Kumoi, Toshiki Shima, Tomohito Iga, Motoki Koide, Takaaki Fujishiro, Okamoto Koji","doi":"10.4055/cios25132","DOIUrl":"10.4055/cios25132","url":null,"abstract":"<p><p>The anterior cortical reference (ACR) technique is introduced as a novel method for determining distal femoral resection alignment in kinematic alignment total knee arthroplasty. This study describes the surgical technique and its potential advantages. The ACR technique utilizes an anterior reference guide positioned subperiosteally along the anterior cortical bone to establish a parallel relationship between the anterior cortex and the cutting block. This method ensures precise femoral component alignment while maintaining a minimally invasive approach. Its benefits include reduced surgical invasiveness and applicability in patients with existing intramedullary implants.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"581-584"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144654","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}