World Journal of Orthopedics最新文献

{"title":"Therapeutic efficacy of thiocolchicoside-nonsteroidal anti-inflammatory drug combination in pain management: A systematic review and cross-sectional real-world study.","authors":"Arnab Karmakar, Akash Jaiswal, Soham Mandal, Afroz Ahmed Khan, Monjori Mitra","doi":"10.5312/wjo.v16.i8.106769","DOIUrl":"10.5312/wjo.v16.i8.106769","url":null,"abstract":"<p><strong>Background: </strong>Thiocolchicoside (TCC), a muscle relaxant with anti-inflammatory properties, is often used alongside nonsteroidal anti-inflammatory drugs (NSAIDs) to treat musculoskeletal pain. This synergistic approach leverages the complementary mechanisms of action, providing more effective relief for conditions such as arthritis, muscle spasms, and soft tissue injuries.</p><p><strong>Aim: </strong>To evaluate the comparative efficacy of the combination therapy of TCC and NSAIDs <i>vs</i> NSAID monotherapy in pain management.</p><p><strong>Methods: </strong>A systematic search of PubMed and Google Scholar databases through October 2024 was performed to evaluate the effectiveness of combined TCC and NSAID therapy <i>vs</i> NSAIDs alone. A retrospective analysis of electronic medical records from India spanning 3 years (2020-2023) examined treatment patterns and focused on clinical outcomes including pain relief, functional improvement, and adverse effects. Key metrics for assessment included visual analog scale scores and hand-to-floor distance, with secondary outcomes assessing patient satisfaction and adverse event (AE) incidence.</p><p><strong>Results: </strong>A systematic literature search revealed seven studies, involving 1137 subjects, aligning with the eligibility criteria from a total of 833 hits. Combination therapy using parenteral TCC with NSAIDs significantly reduced pain intensity [standardised mean difference (SMD): -1.33, <i>P</i> < 0.001] and enhanced functional improvement (SMD: -1.08, <i>P</i> < 0.001) compared to NSAIDs alone. Patients on combination therapy are 6.7 times more likely to experience over 30% pain relief and 5.2 times more likely to achieve over 50% pain relief. Post surgery pain reduction and patient satisfaction were notably higher in the combination group [odds ratio (OR) = 10.14, <i>P</i> < 0.001]. There were no significant differences in mild/moderate AE rates between the groups (OR = 1.30, <i>P</i> = 0.378).</p><p><strong>Conclusion: </strong>Evidence indicates that multimodal therapy, including parenteral TCC with NSAIDs, provides quicker and effective pain relief, reduces muscle spasms, and improves hand-to-floor distance compared to using NSAIDs or TCC alone.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"16 8","pages":"106769"},"PeriodicalIF":2.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors that influence long term instrumentation stability in patients with unstable thoracolumbar injuries.","authors":"Andrey E Bokov, Svetlana Y Kalinina, Daria A Kulagina, Kseniia S Lopyrina, Vladimir V Klinshov, Anatolii A Bulkin","doi":"10.5312/wjo.v16.i8.108161","DOIUrl":"10.5312/wjo.v16.i8.108161","url":null,"abstract":"<p><strong>Background: </strong>Pedicle screw fixation is frequently used to treat unstable thoracolumbar injuries; however, the rate of instrumentation failure remains considerable. The primary contributing factor leading to instrumentation failure is poor bone quality. On the other hand, some evidence suggests that surgical tactics can influence long-term instrumentation stability.</p><p><strong>Aim: </strong>To assess factors that influence the stability of spinal instrumentation in patients with thoracolumbar injuries.</p><p><strong>Methods: </strong>This study is a non-randomized single center ambispective evaluation of 204 consecutive patients (117 men; 87 women) with unstable thoracolumbar injuries. All patients underwent either stand-alone or combined with anterior column reconstruction instrumentation. In cases with spinal cord and nerve root injuries, either posterior or anterior decompression were performed. Patients with pedicle screw loosening were identified <i>via</i> computed tomography imaging. Out of those, cases with clinically significant instrumentation failure were registered.</p><p><strong>Results: </strong>The rate of pedicle screw loosening detected by computed tomography was inversely correlated with bone radiodensity figures and an increased association with the number of instrumented levels, residual kyphotic deformity, laminectomy, and lumbosacral fixation. Intermediate screws and anterior reconstruction were associated with a clinically relevant decreased risk of pedicle screw loosening development. Either complete or partial posterior fusion within instrumented levels was capable of decreasing instrumentation failure risk, while extensive decompression with laminectomy and at least one-level total facetectomy were associated with an increased risk of instrumentation failure. Anterior decompression does not have a negative impact on instrumentation stability.</p><p><strong>Conclusion: </strong>Intermediate screws, anterior reconstruction and posterior tension band preservation are associated with decreased rates of instrumentation instability development. Posterior fusion is beneficial in terms of instrumentation failure prevention.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"16 8","pages":"108161"},"PeriodicalIF":2.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive treatment of far lateral lumbar disc herniation: Selective nerve root block with percutaneous transforaminal endoscopic discectomy.","authors":"Bing Xiao, Xin Gu, Jia-Yi Zhang, Xiao-Jian Ye, Yan-Hai Xi, Guo-Hua Xu, Wei-Heng Wang","doi":"10.5312/wjo.v16.i7.106570","DOIUrl":"10.5312/wjo.v16.i7.106570","url":null,"abstract":"<p><strong>Background: </strong>Far lateral lumbar disc herniation (FLLDH) is a special type of lumbar disc herniation with high rate of missed diagnosis. Selective nerve root block (SNRB) has special advantages in identifying the responsible nerve root. Percutaneous transforaminal endoscopic discectomy (PTED) is a minimally invasive and effective method to treat FLLDH. However, no report has investigated PTED combined with SNRB to treat FLLDH.</p><p><strong>Aim: </strong>To explore the diagnosis and treatment process, surgical technique and clinical efficacy of PTED combined with SNRB to treat FLLDH.</p><p><strong>Methods: </strong>This is a multicenter center, retrospective, observational study. Between January 2020 and January 2022, 32 patients were initially diagnosed with FLLDH. All the patients were identified using SNRB to determine the responsible segment and involved nerve roots. Because of poor symptomatic control following SNRB, 2 patients were excluded. 30 patients diagnosed with FFLDH underwent PTED. The clinical characteristics, operative and postoperative outcomes, complication and subsequent follow-up were collected.</p><p><strong>Results: </strong>30 patients who underwent SNRB combined with PTED were followed up. The average visual analogue scale (VAS)-leg score, VAS-back score, Oswestry disability index (ODI) score at the Follow-up (1 day, 1 month, 3 months and last follow-up) were significantly different compared per-operation. According to the modified Macnab efficacy evaluation standard, the satisfaction degree at the last follow-up was excellent (28, 93.33%), good (1, 3.33%), medium (1, 3.33%) and poor (0, 0%).</p><p><strong>Conclusion: </strong>SNRB provides an effective method for the definite diagnosis of FLDH and responsible nerve roots. Combination therapy offers several advantages including minimal invasiveness, precision, effectiveness, safety and low recurrence rates.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"16 7","pages":"106570"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of lumbar tuberculosis with minimally invasive anterior lesion clearance combined with posterior fixation.","authors":"Fei-Fei Pu, Xiang-Lin Peng, Fang-Zheng Zhou, Xiao-Long Zhao, Ling Yang, Jun-Qing Cao, Liu Wei, Jing Feng, Ping Xia","doi":"10.5312/wjo.v16.i7.106041","DOIUrl":"10.5312/wjo.v16.i7.106041","url":null,"abstract":"<p><strong>Background: </strong>Spinal tuberculosis, a destructive extrapulmonary form, often causes severe deformity and neurological deficits. Surgical intervention aims to debride lesions, reconstruct stability, and correct deformities. This study evaluates a combined posterior fixation and minimally invasive anterior approach for lumbar tuberculosis.</p><p><strong>Aim: </strong>To evaluate the clinical outcomes and radiological parameters of posterior internal fixation combined with minimally invasive anterior lesion clearance and bone graft fusion for the treatment of lumbar tuberculosis.</p><p><strong>Methods: </strong>Clinical data from 24 patients with lumbar tuberculosis who underwent posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance were analyzed. The Cobb angle, visual analog scale (VAS) score, and Frankel classification were statistically assessed preoperatively and postoperatively. Complications and bone graft fusion were also recorded.</p><p><strong>Results: </strong>Wounds healed in the first stage in 22 patients; one patient developed a posterior incisional sinus tract, and one experienced postoperative tuberculosis recurrence. At the final follow-up, according to the Frankel classification, there were 1, 2, and 21 cases classified as grade C, grade D, and grade E, respectively. By the last follow-up, the Cobb angle, VAS score, and erythrocyte sedimentation rate had all decreased. Both X-ray and computed tomography images confirmed bone healing. The fusion time ranged from 3 to 9 months, with an average of 5.2 months.</p><p><strong>Conclusion: </strong>Posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance is an effective and safe treatment for lumbar tuberculosis.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"16 7","pages":"106041"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of the induced membrane technique in aseptic and infected long-bone defect management: Are there any differences?","authors":"Alexander L Shastov, Sergey N Kolchin, Tatiana A Malkova","doi":"10.5312/wjo.v16.i7.107337","DOIUrl":"10.5312/wjo.v16.i7.107337","url":null,"abstract":"<p><p>Management of post-traumatic long-bone defects remains relevant and challenging despite the rapid development of approaches to their treatment. Dominant positions are occupied by the Ilizarov method, bone autogenous grafting and the Masquelet induced membrane technique (IMT). The IMT is aimed at reducing extensive defect treatment duration and for this reason has gained great popularity. However, the assessment of its effectiveness is difficult due to a limited number of clinical series. The varying clinical manifestations of bone defect severity do not allow a comprehensive evaluation of IMT effectiveness. One of them is infection in the defect area. The purpose of our literature review is an analysis of studies on IMT application in infected <i>vs</i> non-infected long-bone defects of the lower extremitie<b>s</b> published over the last 10 years. It focuses on the investigation of similarities and fundamental differences in the need for antibiotics, timing of spacer fixation, methods of collecting donor bone and fixators used for consolidation. The studies show that the IMT has been globally used in aseptic and osteomyelitic defects due to its clinical effectiveness. Authors' variations and improvements in its practical implementation indicate the ongoing development and the interest of researchers in this technique.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"16 7","pages":"107337"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulnar lengthening in the treatment of forearm deformity caused by hereditary multiple exostoses in children.","authors":"Shuo Wang, Huan-Rong Liu, Kai-Tai Zou, Feng Gao, Shang-Yu Wang, Blessing Mutasa, Jin Li, Pan Hong","doi":"10.5312/wjo.v16.i7.108319","DOIUrl":"10.5312/wjo.v16.i7.108319","url":null,"abstract":"<p><p>Hereditary multiple exostoses (HME) is an autosomal dominant bone disorder characterized by abnormal bone development. HME mostly involves the forearm, resulting in forearm deformities, limited functional activities, <i>etc</i>. Currently, there are multiple surgical methods including tumor resection with or without ulnar osteotomy and lengthening, simple radial head resection and distal radial hemiepiphysiodesis, but the optimal treatment remains controversial. Ulnar lengthening serves as an effective surgical intervention for forearm deformities in HME patients. This review examines its surgical techniques, complications, and timing of the operation to guide clinical decision-making for improving function and cosmetic outcomes.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"16 7","pages":"108319"},"PeriodicalIF":2.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of clinical outcomes between biportal and uniportal full-endoscopy techniques in lumbar spinal stenosis with bilateral symptoms.","authors":"Song Guo, Rui-Ning Hang, Kai Zhu, Chen-Qiong Wu, Mei-Jun Yan, Xin-Hua Li, Yan-Bin Liu, Qiang Fu","doi":"10.5312/wjo.v16.i7.107698","DOIUrl":"10.5312/wjo.v16.i7.107698","url":null,"abstract":"<p><strong>Background: </strong>Uniportal full-endoscopy (UFE) technique has been continuously developed and applied for treating lumbar spinal stenosis. However, achieving effective decompression outcome of using the UFE technique remains technically demanding and uncertain. Previously, we have proposed the biportal full-endoscopy (BFE) technique to integrate the respective advantages of both UFE and unilateral biportal endoscopy technique. There is limited published data on the comparison of clinical outcomes between biportal and UFE techniques in lumbar spinal stenosis with bilateral symptoms.</p><p><strong>Aim: </strong>To contrast the clinical outcomes between biportal and UFE techniques for treating lumbar spinal stenosis with bilateral symptoms.</p><p><strong>Methods: </strong>This study retrospectively examined 100 patients diagnosed with lumbar spinal stenosis and bilateral symptoms. Among them, 52 cases were part of group A (BFE technique group), and 48 cases belonged to group B (UFE technique group). The visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified Macnab criteria were used to evaluate the clinical outcomes.</p><p><strong>Results: </strong>Group A had significantly shorter operation time than group B. Both groups experienced substantial relief in lower back and lower extremity pain on the severe side at postoperative 3 days, 3 months, and 12 months. Group A had notably lower VAS scores for mild side lower extremity pain at postoperative 3 months and 12 months compared to group B. Group A's ODI scores were significantly lower at postoperative 3 months and 12 months, whereas group B's scores did not significantly differ from preoperative values. Group A's ODI scores were significantly lower than group B's at postoperative 3 months and 12 months. Group A had a significantly higher excellent and good response rate (94.23%) compared to group B (81.25%) at postoperative 12 months based on the modified Macnab scale outcomes.</p><p><strong>Conclusion: </strong>The BFE technique offers multiple benefits, including reduced trauma and quicker recovery as a minimally invasive surgery, and enhanced decompression efficiency over the UFE technique when treating lumbar spinal stenosis with bilateral symptoms.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"16 7","pages":"107698"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel handheld pelvic alignment guide for hollow screw fixation in osteoporotic pelvic fragility fractures.","authors":"Yuan Wang, Zhen-Yu Tan, Jie-Ming He, Yue-Xia Shu, Zhen Pan, De-Gang Zhu, Jia Wang","doi":"10.5312/wjo.v16.i7.107087","DOIUrl":"10.5312/wjo.v16.i7.107087","url":null,"abstract":"<p><strong>Background: </strong>Retrograde pubic ramus screw placement is an effective technique but requires substantial surgical expertise and specialized equipment. The management of osteoporotic anterior pelvic ring injuries remains challenging due to technical difficulties and a high risk of complications.</p><p><strong>Aim: </strong>To introduce a novel and simplified surgical approach that utilizes a custom-designed handheld pelvic alignment guide (HPAG) in combination with a 6.0 mm hollow screw, aiming to enhance the accuracy, efficiency, and safety of retrograde pubic ramus screw fixation in osteoporotic pelvic fragility fractures.</p><p><strong>Methods: </strong>The HPAG and 6.0 mm hollow screw were employed during surgical treatment. A 2.0-3.0 cm incision was made to expose the optimal screw entry point. Intraoperative pelvic inlet and obturator oblique views were used to monitor fracture reduction and guide screw insertion. Clinical outcomes and fracture reduction quality were evaluated using Matta, visual analog scale, and Majeed scores during follow-ups. A representative case is presented to demonstrate the surgical procedure in detail.</p><p><strong>Results: </strong>No perioperative complications were observed. The mean operative time was 35.2 ± 6.97 minutes, with a screw insertion time of 7.25 ± 1.86 minutes, an average incision length of 2.8 ± 0.67 cm, and mean blood loss of 43.25 ± 15.64 mL. At one-year follow-up, seven patients achieved excellent Majeed scores and three achieved good scores.</p><p><strong>Conclusion: </strong>The HPAG technique significantly shortens operative time, minimizes surgical trauma, and facilitates accurate screw placement. It presents a promising and efficient approach for managing fragility fractures of the pelvis, especially in osteoporotic patients.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"16 7","pages":"107087"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term survivorship of Truliant^® total knee arthroplasty implants utilizing the American Joint Replacement Registry.","authors":"Kirstin Jones, Amber M Muehlmann, Mark Musgrave, Colin T Penrose","doi":"10.5312/wjo.v16.i7.106281","DOIUrl":"10.5312/wjo.v16.i7.106281","url":null,"abstract":"<p><strong>Background: </strong>Truliant^® posterior stabilized (PS) and Truliant cruciate retaining (CR) are two designs used for total knee arthroplasty. Survivorship and reason for revision rates are now available from the American Joint Replacement Registry (AJRR) at short-term time points for both Truliant designs. It was hypothesized that Truliant PS and Truliant CR perform comparably to similar designs in terms of survivorship.</p><p><strong>Aim: </strong>To analyze short-term survivorship of Truliant PS or CR total knee arthroplasty relative to non-Truliant PS or CR total knee arthroplasty.</p><p><strong>Methods: </strong>Utilizing data from the AJRR, a retrospective review was performed for subjects who underwent implantation of Truliant PS, Truliant CR, non-Truliant PS, and non-Truliant CR designs as of June 30, 2022. Survivorship and reasons for revision were compared statistically between Truliant PS <i>vs</i> non-Truliant PS as well as Truliant CR <i>vs</i> non-Truliant CR groups. Cumulative percent revision rates were compared across three registries, AJRR, Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and the United Kingdom National Joint Registry (UK NJR).</p><p><strong>Results: </strong>Truliant PS survivorship was 97.95% at the four-year mark, while Truliant CR survivorship was 99.61% at the three-year mark. There were no significant differences in survivorship hazard ratios or reasons for revision for both Truliant groups <i>vs</i> non-Truliant comparison aggregate groups at short-term time points. Cumulative percent revision rate comparisons were made to device appropriate groups from AJRR, AOANJRR, and UK NJR data. Truliant PS cumulative percent revision rates were similar to non-Truliant cumulative percent revision rates in the AJRR and similar to AOANJRR and UKNJR at both one and three years. Truliant CR cumulative percent revision rates were lower than aggregate AJRR, AOANJRR, and UK NJR cumulative percent revision rates at the one-year and three-year marks.</p><p><strong>Conclusion: </strong>This study demonstrates high survivorship for Truliant PS total knee arthroplasty out to four-years and Truliant CR total knee arthroplasty out to three-years of follow-up.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"16 7","pages":"106281"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of cementless bipolar hemiarthroplasty and proximal femoral nail anti-rotation in unstable intertrochanteric fractures: A meta-analysis.","authors":"Ahmed Mohamed Yousif Mohamed, Monzir Salih, Mugahid Mohamed, Ayman E Abbas, Maysara Elsiddig, Moaz Osama Omar, Mazin Abdelsalam, Basil Elhag, Nujud Mohamed, Souzan Hassan Eisa Ahmed, Samah Ahmed, Duaa Mohamed, Deena Omar","doi":"10.5312/wjo.v16.i7.107950","DOIUrl":"10.5312/wjo.v16.i7.107950","url":null,"abstract":"<p><strong>Background: </strong>Unstable intertrochanteric fractures in elderly patients require effective surgical management, with both cementless bipolar hemiarthroplasty (CBHA) and proximal femoral nail anti-rotation (PFNA) being valid treatment options to reduce morbidity and mortality.</p><p><strong>Aim: </strong>To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.</p><p><strong>Methods: </strong>A comprehensive search was conducted to identify relevant studies discussing the outcomes of using both CBH and PFNA in treatment of unstable intertrochanteric fractures. Studies published up to January 1, 2025 were searched across multiple databases, including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar. Full texts of the selected articles were retrieved, reviewed, and independently assessed by the investigators. Discrepancies were resolved by consensus, with any remaining disagreements being arbitrated by a third author.</p><p><strong>Results: </strong>This meta-analysis included three studies, all of which were retrospective, involving a total of 240 patients. The follow-up period for participants was at least 12 months. CBHA was associated with significantly higher blood loss compared to PFNA [mean differences (MD): 129.14, 95%CI (52.51, 205.77), <i>P</i> = 0.001], though heterogeneity was high (<i>I</i>² = 97%). Operative time showed no significant difference initially [MD: 6.10, 95%CI (-13.34, 25.54), <i>P</i> = 0.54], but after excluding one study, BHA had longer operative times [MD: 21.51, 95%CI (18.60, 24.41), <i>P</i> < 0.00001]. Hospital stay and Harris scores showed no significant differences between groups. CBHA facilitated faster progression to weight-bearing [MD: -11.92, 95%CI (-22.46, -1.39), <i>P</i> = 0.03] and a lower incidence of prosthetic loosening [risk ratio: 0.21, 95%CI (0.05, 0.92), <i>P</i> = 0.04]. Refracture and thrombus formation rates were comparable between the two groups.</p><p><strong>Conclusion: </strong>CBHA offers shorter weight-bearing duration and reduced prosthetic loosening but incurs greater blood loss and longer operative times compared to PFNA. Both techniques show comparable functional recovery, hospital stay, refracture, and thrombus risks. Clinical choice should prioritize early mobilization or surgical minimalism, guided by patient needs. Further prospective studies are warranted.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"16 7","pages":"107950"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}