Journal of Orthopaedics and Traumatology最新文献

{"title":"Five-year outcomes of medial open-wedge high tibial osteotomy with lateral supplemental lag screw in patients with obesity.","authors":"Yu-Hung Tian, Kun-Han Lee, Chen-Wen Huang, Shin-Yiing Lin, Jesse Chieh-Szu Yang","doi":"10.1186/s10195-026-00924-8","DOIUrl":"https://doi.org/10.1186/s10195-026-00924-8","url":null,"abstract":"<p><strong>Background: </strong>Obesity contributes to the accelerated progression of knee osteoarthritis. Medial open-wedge high tibial osteotomy (MOWHTO) is a joint-preserving surgical intervention for unicompartmental knee osteoarthritis; however, its efficacy in patients with obesity remains controversial. This study aimed to evaluate the 5-year clinical and radiographic outcomes of MOWHTO with lateral supplemental lag screw fixation in patients with obesity.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included patients with obesity who underwent MOWHTO between 2017 and 2020, with a minimum follow-up of 5 years. All procedures were performed by a single surgeon using three-dimensional printed, patient-specific instrumentation, locking plates, and a lateral supplemental lag screw. Clinical outcomes were assessed using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic parameters, including the weight-bearing line percentage (WBL%) and medial proximal tibial angle (MPTA), were evaluated.</p><p><strong>Results: </strong>Significant improvements in VAS and WOMAC scores were observed at all postoperative time points (p < 0.001) and were accompanied by improved radiographic alignment, with WBL% shifting toward the Fujisawa point and increased MPTA values. At 5 years, mild regression in alignment was noted; however, the overall correction was maintained. The 5-year conversion rate of TKA was 3.8%. Lateral hinge fractures occurred in 3.8% of cases and healed without loss of correction.</p><p><strong>Conclusions: </strong>Medial open-wedge high tibial osteotomy is associated with satisfactory 5-year clinical and radiographic outcomes in patients with obesity. Obesity is not necessarily a contraindication for HTO, although appropriate patient selection and long-term follow-up are essential for this procedure.</p><p><strong>Level of evidence: </strong>III, Retrospective cohort study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do modular tapered long stems differ in stability and function? A prospective comparison of two stems in complex femoral revision THA.","authors":"Mahmoud Fahmy, Mostafa Ahmed Shawky","doi":"10.1186/s10195-026-00925-7","DOIUrl":"10.1186/s10195-026-00925-7","url":null,"abstract":"<p><strong>Background: </strong>Revision total hip arthroplasty (rTHA) in the setting of substantial proximal femoral bone loss is technically challenging. Modular tapered fluted stems provide predictable diaphyseal fixation while allowing independent adjustment of version, offset, and limb length. Among these, two commonly used systems-modular tapered fluted stem Type A (Revitan^™) and Type B (LIMA Modulus^™)-have limited direct comparative evidence. This study aimed to prospectively compare radiographic stem subsidence (primary outcome), as well as functional outcomes, complications, survivorship, and secondary outcomes, between Type A and Type B modular long stems in femoral rTHA.</p><p><strong>Methods: </strong>In this single-center randomized prospective study, 110 patients undergoing femoral revision rTHA were randomly assigned to receive either Type A (n = 55) or Type B (n = 55) stems. All procedures were performed by experienced revision surgeons under standardized perioperative and rehabilitation protocols. Radiographs were analyzed for stem subsidence, osseointegration, and limb-length restoration. Functional outcomes were assessed using the Harris Hip Score (HHS), Oxford Hip Score (OHS), and European Quality of Life Visual Analogue Scale (EQ-VAS) at baseline and final follow-up (mean 61.4 months). Complications and stem survivorship were recorded prospectively. Statistical analysis included paired and unpaired comparisons, correlation, regression, and Kaplan-Meier survival estimates.</p><p><strong>Results: </strong>Baseline demographics and femoral defect severity were comparable. Both groups achieved high radiological stability, with mean distal subsidence of 1.3 ± 0.7 mm (Type A) and 1.5 ± 0.9 mm (Type B; p = 0.24), and osseointegration in > 92% of cases. Limb-length and offset restoration were similar. HHS improved significantly in both groups (Type A: 44.7 → 88.1; Type B: 45.1 → 87.3; p < 0.001), with > 80% achieving good-to-excellent outcomes. Complication rates were low and comparable. Five-year stem survivorship was 98.2% (Type A) and 97.6% (Type B). Early full weight-bearing and lower Paprosky defect grades independently predicted superior functional outcomes, whereas stem type did not.</p><p><strong>Conclusions: </strong>Both Type A and Type B modular tapered fluted stems demonstrated durable fixation, minimal subsidence, low complication rates, and excellent mid-term functional recovery. Radiographic stem subsidence did not differ between groups, indicating that design variations do not significantly affect clinical outcomes. These findings support the use of modular tapered fluted stems as reliable solutions in complex femoral rTHA.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822420","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 fixation of osteochondral fracture: a systematic review.","authors":"Alexander Shao-Rong Pang, Ramesh Oviya, Jarell Jie-Rae Tan, Kean Seng Andrew Lim, James Hoi Po Hui, Si Heng Sharon Tan","doi":"10.1186/s10195-026-00926-6","DOIUrl":"https://doi.org/10.1186/s10195-026-00926-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Dealing with knee osteochondral defects presents a substantial clinical challenge due to the variable nature of repair outcomes and intricate biomechanical complexities inherent to the knee joint. Numerous surgical alternatives exist for addressing knee osteochondral lesions, yet there is limited evidence available for comparing their respective outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;According to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines, a systematic literature search was conducted to identify publications from inception to September 2023 on PubMed, Cochrane, and Medline academic search engines with the MeSH terms \"osteochondral\" AND (\"patella\" OR \"patellar\" OR \"patellofemoral\" OR \"femoral condyle lesions\" OR \"trochlear lesions\"). Inclusion criteria were clinical human studies, English language, subjects who underwent surgical management (fixation, reconstruction, or debridement) for knee osteochondral lesions with reported treatment outcomes, and a minimum sample size of ten patients. The methodological index for non-randomized studies (MINORS) was used to evaluate the non-randomized studies' methodological quality. Main outcome measurements Pediatric International Knee Documentation Committee (Pedi IKDC) scale, Tegner-Lysholm Scoring Scale, Tegner Activity Score, Visual Analog Scale, Knee Society Score (KSS) Score, Kujala Score, and Fulkerson score were collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In all, 25 studies were included with 1093 patients in total. The analysis revealed that patellar lesions had similar outcomes to femoral lesions. Surgical fixation demonstrated superior outcomes compared with debridement, with improvements observed across multiple validated outcome measures. Both fixation and reconstruction resulted in significant improvement in outcomes. Osteochondral fragment size, age, and sex did not influence postoperative outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;While surgical management of knee osteochondral defects consistently yields significant functional improvement, the current evidence favors anatomic restoration via fixation or reconstruction over debridement. Despite the variability in patient demographics and reported outcomes, these findings suggest that treatment selection should be prioritized on the basis of lesion characteristics and specific surgical technique rather than age alone. However, given the significant heterogeneity, wide age range, and missing demographic data across the literature, these findings should be interpreted as observed associations rather than definitive evidence of clinical superiority. They underscore the need for tailored treatment strategies and highlight the requirement for high-level, standardized research with consistent use of validated outcome measures and established minimal clinically important difference (MCID) thresholds to further clarify optimal surgical interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical comparison of single posterolateral plate with medial-cannulated-screw fixation and double-plate fixation for extra-articular distal humerus fractures.","authors":"Hyoung-Seok Jung, Min-Su Chu, Jae-Sung Lee","doi":"10.1186/s10195-026-00918-6","DOIUrl":"https://doi.org/10.1186/s10195-026-00918-6","url":null,"abstract":"<p><strong>Background: </strong>Double-plate fixation is the gold standard for extra-articular distal humerus fractures, but it carries a substantial risk of postoperative ulnar neuropathy. Fixation using a single posterolateral plate with a medial cannulated screw may reduce ulnar neuropathy while maintaining fracture stability. This study aimed to compare the clinical outcomes of single-plate-with-medial-screw fixation versus double-plate fixation for extra-articular distal humerus fractures.</p><p><strong>Materials and methods: </strong>Fifty-six patients who underwent surgery for extra-articular distal humerus fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA] classification A2 or A3) between January 2018 and August 2024 were divided into a double-plate group and a single-plate-with-medial-screw group. We conducted a retrospective, nonrandomized comparative study. The double-plate fixation was used in 30 patients from January 2018 to October 2021, while the single-plate fixation with a medial screw was used in 26 patients from November 2021 to August 2024. All surgeries were performed using a posterior paratricipital approach. Bony union, radiographic healing, and loss of reduction were evaluated. Postoperative pain scores (visual analog scale at 2 days after the operation), operative time (minutes), elbow range of motion, elbow function (Mayo Elbow Performance Score [MEPS]), and the presence of postoperative ulnar neuropathy were compared between the two groups.</p><p><strong>Results: </strong>The double-plate fixation and single-plate fixation with a medial screw were performed in 30 and 26 patients, respectively. The mean age was 54.8 ± 19 (range, 17-85) years, and the mean follow-up duration was 18.2 ± 6.5 (range, 12-38) months. All fractures achieved solid osseous union at final follow-up. No significant differences were observed between the groups in terms of postoperative pain score, range of motion, and MEPS (all p > 0.05). However, the operative time was shorter for the single-plate-with-medial-screw group than that for the double-plate group (112.5 ± 25.7 versus 172.2 ± 35.2 min, p < 0.05), and the operative time was significantly associated with the fixation method (p < 0.05). In addition, postoperative ulnar neuropathy occurred less frequently with the single-plate-with-medial-screw group than with the double-plate group (8% versus 37%, p = 0.013).</p><p><strong>Conclusions: </strong>Both double-plate and single-plate-with-medial-screw fixation showed comparable union rates and functional outcomes in extra-articular distal humerus fractures. However, single-plate fixation with a medial screw required a shorter operative time and was associated with a lower incidence of postoperative ulnar neuropathy than double-plate fixation. Level of evidence Level III, retrospective comparative study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A study on the association between tibial plateau fractures and intra-articular soft-tissue injuries under valgus injury mechanisms.","authors":"Shuo Duan, Shuaishuai Wang, Tongtong Zhu, Qinghan Li, Minglei Zhang","doi":"10.1186/s10195-026-00927-5","DOIUrl":"https://doi.org/10.1186/s10195-026-00927-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;While recent investigations have focused on injury mechanism classifications of tibial plateau fractures (TPFs), the association between valgus TPFs and concomitant soft-tissue damage involving menisci and ligaments remains insufficiently elucidated. This study aimed to characterize intra-articular soft-tissue injuries associated with various valgus TPFs and assess the predictive value of lateral plateau depression (LPD) and widening (LPW). Additionally, the analysis extended to other injury mechanisms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This study included adult patients with acute tibial plateau fractures who had complete imaging data, excluding patients with open fractures and multiple fractures throughout the body. Imaging examinations were used to assess the fracture mechanism and intra-articular soft-tissue damage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study retrospectively analyzed the clinical data of 138 patients with valgus injury TPFs in our hospital. The study compared the incidence of TPFs with intra-articular soft-tissue damage under different injury mechanisms. The result demonstrated that the incidence of valgus hyperextension TPFs combined with medial collateral ligament injuries was relatively high (61.5%) compared with TPFs with other injury mechanism. Multivariable logistic regression and smooth curve fitting revealed significant dose-response relationships of LPD (odds ratio [OR] = 1.408; 95% confidence interval [CI] 1.217, 1.627) and LPW (OR = 1.782; 95% CI 1.387, 2.290) with the risk of lateral meniscus (LM) tears in valgus TPFs. Receiver operating characteristic curves showed the area under the curve (AUC) values and the optimal thresholds of LPD and LPW. For all valgus TPFs, the AUCs of LPD and LPW associated with LM tear were 0.804 (95% CI 0.728, 0.880) and 0.741 (95% CI 0.657, 0.825), respectively. And the optimal threshold for LPD to predict LM tears was 7.11 mm (sensitivity 0.80, specificity 0.74). Subgroup analysis by injury mechanism further demonstrated that, under the valgus extension injury mechanism, the optimal threshold was 8.45 mm (sensitivity 0.68, specificity 0.91). Under the valgus flexion injury mechanism, the optimal threshold was 7.18 mm (sensitivity 0.69, specificity 0.87). Further analyses revealed that varus flexion TPFs demonstrated elevated risks of anterior cruciate ligament injuries (82.5%), lateral collateral ligament injuries (65.0%), and meniscal tears (70.0%), whereas varus hyperextension TPFs showed higher posterior cruciate ligament injury prevalence (56.3%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;LPD serves as a reliable predictor of fractures combined with LM tears. Specifically, under the overall valgus injury mechanism, the possibility of LM tears (particularly the posterior horn tears) should be guarded against when LPD exceeds 7.11 mm. For the valgus extension subtype, the possibility of LM tears (especially the anterior horn tears) should be high","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The coronoid as the key fragment of trans-ulnar fracture-dislocations of the elbow: Insights from a retrospective cohort comparison using the coronoid-centric Mayo classification system.","authors":"Leopold Henssler, Maximilian Kerschbaum, Miriam Zanklmaier, Leon Alexander Wieczorek, Volker Alt, Lisa Klute","doi":"10.1186/s10195-026-00921-x","DOIUrl":"https://doi.org/10.1186/s10195-026-00921-x","url":null,"abstract":"<p><strong>Background: </strong>Trans-ulnar fracture-dislocations of the elbow are rare injuries with complex fracture patterns and variable outcomes. Traditional classification systems offer limited prognostic value. A recently introduced coronoid-centric Mayo classification distinguishes injury subtypes based on coronoid attachment and identifies trans-ulnar basal coronoid (TUBC) fractures as a particularly challenging entity. This study evaluated outcomes across Mayo fracture types and explored factors associated with inferior results in TUBC injuries.</p><p><strong>Materials and methods: </strong>In this retrospective cohort study, surgically treated trans-ulnar elbow fracture-dislocations managed at a level I trauma center between 2010 and 2022 were identified and classified according to the Mayo system. Demographic data, injury characteristics, surgical management, radiographic outcomes, and complications were recorded. Functional outcomes were assessed after a minimum follow-up of 12 months using the Mayo Elbow Performance Score (MEPS); Oxford Elbow Score (OES); Quick Disabilities of Arm, Shoulder and Hand Questionnaire (QuickDASH); European Quality of Life Five-Dimension, Five-Level Version (EQ-5D-5L); and range-of-motion measurements. Radiographs were analyzed for union, instability, heterotopic ossification, and post-traumatic osteoarthritis (OA).</p><p><strong>Results: </strong>A total of 52 patients were included (14 trans-olecranon, 28 TUBC, 10 Monteggia-variant). TUBC injuries were the most common subtype (53.8%). Post-traumatic OA was significantly more frequent in TUBC injuries than in fractures with coronoid attachment to a major fragment (88% versus 61%, P = 0.047). Higher-grade OA and persistent instability were associated with inferior functional outcomes. Although functional scores tended to be lower in TUBC injuries, differences compared with other subtypes were not consistently statistically significant. Within the TUBC group, poorer outcomes were observed when stable screw fixation of the basal coronoid fragment could not be achieved.</p><p><strong>Conclusions: </strong>TUBC fracture-dislocations represent a high-risk subgroup of trans-ulnar elbow injuries. Stable fixation of the coronoid base appears critical for achieving favorable outcomes. The Mayo classification provides clinically relevant stratification and prognostic insight for these complex injuries.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"27 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785647","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":"Favorable subjective clinical outcomes after revision hip arthroscopy for femoroacetabular impingement syndrome despite a high rate of capsular defects and increased capsular thickness.","authors":"Zhuohan Cao, Guanying Gao, Weijie Lin, Yichuan Zhu, Xiang Zhou, Jianquan Wang, Yan Xu","doi":"10.1186/s10195-026-00922-w","DOIUrl":"https://doi.org/10.1186/s10195-026-00922-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The capsular healing status and capsular thickness changes in patients with femoroacetabular impingement syndrome (FAIS) following revision hip arthroscopy are poorly documented, and their relationship with subjective clinical outcomes remains unclear. The purpose of this work is to evaluate the incidence of capsular defects and changes in capsular thickness using magnetic resonance imaging (MRI) following hip arthroscopy in patients with FAIS, and to compare the subjective clinical outcomes between patients with and without capsular healing after revision hip arthroscopy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;Consecutive patients with FAIS who underwent revision hip arthroscopy between 2013 and 2023 were included. Patients were categorized into two groups on the basis of capsular healing status after revision hip arthroscopy. Patient-reported outcomes (PROs) were collected preoperatively and at minimum 2-year follow-up, including the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score-Activity of Daily Living Scale (HOS-ADL), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS). Achievements in minimal clinically important difference (MCID) and patient acceptable symptom state (PASS), patient satisfaction, and re-revision rates were evaluated and compared between groups. Capsular thickness was assessed by MRI pre-index, pre-revision, and at a minimum of 12-month post-revision time points in cases with healed capsule. Spearman rank correlation analysis was performed to assess the association between PROs and capsular thickness postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 19 patients (20 hips) were included. Capsular defects were observed in six hips (30%) at minimum 1 year follow-up following revision hip arthroscopy. No significant differences were identified between the healed and unhealed groups in patient demographics, intraoperative findings, arthroscopic procedures, or preoperative PROs (P &gt; 0.05). Postoperative PROs, MCID and PASS achievement rates, patient satisfaction, and re-revision rates were also comparable between groups (P &gt; 0.05). The proximal (P = 0.015) and middle (P = 0.009) capsular thickness significantly increased at the final follow-up after revision hip arthroscopy compared to pre-revision surgery time point. No significant correlations were found between capsular thickness and PROs following revision hip arthroscopy (P &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although the rate of capsular defects following revision hip arthroscopy was 30% at minimum 1 year follow-up, comparable improvements in subjective clinical outcomes were observed at minimum 2-year follow-up regardless of capsular healing status. Patients with healed capsules exhibited increased proximal and middle capsular thickness after revision hip arthroscopy, with no correlation observed between capsular thickness and PROs.&lt;/p&gt;&lt;p&gt;","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility study of a robot-assisted endoscopic technique for plate osteosyntheses of the acetabulum and anterior pelvic ring.","authors":"Nico Hinz, Gerrit Althoff, Michael Thomaschewski, Lars Arne Bonke, Alexandra Eberenz, Matthias Münch, Lina Behrends, Georg Männel, Dennis Kundrat, Imke Weyers, Arndt-Peter Schulz, Tobias Keck, Karl-Heinz Frosch, Maximilian Hartel","doi":"10.1186/s10195-026-00920-y","DOIUrl":"10.1186/s10195-026-00920-y","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive stabilization of acetabular and pelvic ring fractures using endoscopic techniques has become increasingly important. The logical advancement of conventional endoscopic techniques is a robot-assisted approach, which benefits from the advantages of robot-assistance systems (e.g., more degrees of freedom for instruments and improved visualization). The aim was therefore to investigate the feasibility of a robot-assisted endoscopic technique for plate osteosyntheses of the acetabulum and anterior pelvic ring.</p><p><strong>Materials and methods: </strong>In this two-part feasibility study, four different plate osteosyntheses were performed endoscopically using the Hugo™ robot-assisted surgery system, first on ten synthetic pelvic models and then on ten human cadavers. During robot-assisted dissection for the preperitoneal approach, identification of ten relevant anatomical landmarks was also assessed. In both parts, the success, number of drilling errors, and time for each plate were described as learning curves and analyzed using linear regression.</p><p><strong>Results: </strong>The infrapectineal plate could be successfully performed in 100% of synthetic models, the posterior column plate in 100%, the suprapectineal plate in 90%, and the superior pubic ramus plate in 80%. Learning curves could be observed for the number of drilling errors per plate (e.g., 0.67 to 0, p = 0.009) and the time required, but they were mostly nonsignificant. In the ten human cadavers, all ten anatomical landmarks could be identified and all four plate osteosyntheses could be performed from the third attempt on (attempt 1: 6/10 landmarks, 3/4 plates; attempt 2: 7/10 landmarks, 3/4 plates). The time decreased for the superior pubic ramus plate (98 to 15 min, p = 0.002), suprapectineal plate (55 to 25 min, p = 0.013), infrapectineal plate (50 to 10 min, p = 0.004), and nonsignificantly for the posterior acetabular column plate (31 to 21 min). The average number of drilling errors per plate decreased nonsignificantly (1 to 0.5).</p><p><strong>Conclusions: </strong>Plate osteosynthesis for the acetabulum and anterior pelvis is feasible using a robot-assisted endoscopic technique but is more time-consuming than using a conventional endoscopic technique and is associated with technical challenges, such as screw angulation. With the development of specialized instruments for pelvic trauma surgery, endoscopic and robot-assisted techniques will likely play a significant role in the future.</p><p><strong>Level of evidence: </strong>Level 5.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13091822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693156","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":"From bench to bedside: a novel suture-augmented prosthesis for greater trochanteric fixation in osteoporotic hip arthroplasty.","authors":"Maolin Yang, Junjun Yang, Xu Wang, Zhangwei Wu, Sijie Bian, Rui Sheng, Faxue Liao, Kunpeng Qin, Chi Zhang, Huaiping Yuan, Xiaoqin Ding, Congying Xie, Guangwen Ma, Jun Chang","doi":"10.1186/s10195-026-00919-5","DOIUrl":"https://doi.org/10.1186/s10195-026-00919-5","url":null,"abstract":"<p><strong>Background: </strong>Stable fixation of the greater trochanter during hip arthroplasty for unstable osteoporotic intertrochanteric fractures remains a significant challenge. Conventional techniques depend on securing the bone-implant interface, which is particularly compromised in osteoporotic bone. Here, we propose a novel conceptual approach that establishes a direct mechanical bridge from the abductor tendon to the prosthesis, thereby reducing reliance on the fragile bone-implant interface.</p><p><strong>Methods: </strong>In this two-stage translational study, we progressed from biomechanical validation to clinical application. First, using a decalcified caprine femoral model simulating osteoporosis, three fixation constructs were compared: locking plate (LP), suture-augmented locking plate (LPSA), and Kirschner-wire tension band (KWTB). Ultimate load and construct stability were evaluated. Biomechanical testing confirmed the principle of suture-mediated load sharing and highlighted the intrinsic weakness of screw fixation in osteoporotic bone. Guided by these results, we designed a novel femoral prosthesis that eliminates screw fixation, employs sutures as the primary load-bearing element, and incorporates integrated suture anchor tunnels. This prosthesis was then assessed in a retrospective series of 15 consecutive elderly patients with osteoporotic intertrochanteric fractures. Clinical outcomes were evaluated using the Harris Hip Score (HHS).</p><p><strong>Results: </strong>Biomechanically, the LPSA construct sustained a significantly higher ultimate load than the LP construct in decalcified bone (P < 0.001) and exhibited a greater load at 2-mm displacement than the KWTB construct (P < 0.001). Clinically, all patients achieved fracture union without prosthesis-related complications. The mean HHS at final follow-up was 88.27 ± 6.60, and 80% of patients regained independent ambulation.</p><p><strong>Conclusions: </strong>A prosthesis-anchored, suture-mediated \"tendon-to-prosthesis\" load pathway provides reliable stabilization of the greater trochanter in osteoporotic bone. Biomechanical validation and favorable early clinical outcomes support the potential of this novel fixation strategy.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updating radiographic parameters for the healthy growing hip: are current parameters still valid?","authors":"Konstanze Hütter, Maria Anna Smolle, Sophie Butter, René Schroedter, Sebastian Tschauner, Tanja Kraus","doi":"10.1186/s10195-026-00917-7","DOIUrl":"https://doi.org/10.1186/s10195-026-00917-7","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate whether the acetabular angle (AA) by Tönnis and lateral center-edge angle (LCEA) by Wiberg-key radiographic parameters in pediatric hip assessment-have changed in a contemporary pediatric population compared with historical reference values, considering trends in earlier skeletal maturation and body composition.</p><p><strong>Materials and methods: </strong>This retrospective diagnostic accuracy study assessed changes in AA and center-edge angle (CE) angles in a contemporary cohort. A total of 1774 anteroposterior pelvic radiographs (3548 hips) from patients aged 0-18 years without hip pathology were analyzed. Radiographs were obtained between 2006 and 2018 and measured using the Supervisely digital platform. Standardized anatomical landmarks were applied. Data were stratified by age and sex and compared with historical values using two-sample t-tests (p < 0.05). To minimize measurement bias, two independent observers conducted all assessments using standardized digital protocols.</p><p><strong>Results: </strong>A total of 1774 patients aged 0-18 years (mean age, 8.30 ± 5.20 years; 666 females, 1108 males) were evaluated. AA values did not show statistically significant differences in 11 of 16 age groups compared with historical data (p > 0.05). In contrast, LCEAs were significantly higher in the contemporary cohort, especially in the 5-8, 9-12, and 12-16 age groups (all p < 0.01), indicating a trend toward earlier or increased acetabular ossification and femoral head coverage.</p><p><strong>Conclusions: </strong>LCEA values were significantly higher in the contemporary pediatric cohort compared with historical data, while AA values remained stable across most age groups. These findings suggest that current radiographic reference standards for LCEA may warrant reassessment to ensure accurate dysplasia assessment.</p><p><strong>Level of evidence: </strong>level 3 (diagnosis).</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}