Journal of Orthopaedics and Traumatology最新文献

{"title":"Minimal clinically important difference (MCID), patient-acceptable state (PASS), minimally detectable change (MDC), and substantial clinical benefit (SCB) in patients who have undergone arthroscopic surgery for femoroacetabular impingement: a systematic review.","authors":"Filippo Migliorini, Nicola Maffulli, Luise Schäfer, Madhan Jeyaraman, Marcel Betsch, Mohamed Mahmoud","doi":"10.1186/s10195-026-00951-5","DOIUrl":"10.1186/s10195-026-00951-5","url":null,"abstract":"<p><strong>Introduction: </strong>Hip arthroscopy has been established as a successful management for femoroacetabular impingement (FAI) syndrome. Patient-reported outcome measures (PROMs) are frequently used to assess treatment results in patients. However, clinically important outcome values have recently been calculated to better understand and interpret PROMs and define successful treatment. This systematic review aimed to investigate the minimal clinically important difference (MCID), patient-acceptable state (PASS), substantial clinical benefit (SCB), and minimally detectable change (MIC) of the most commonly used PROMs for assessing patients who have undergone arthroscopic surgery for FAI.</p><p><strong>Material and methods: </strong>This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. In October 2025, the following databases were accessed: PubMed, Web of Science, and Embase. All clinical studies investigating tools to assess the clinical relevance of PROMs used to evaluate patients who have undergone arthroscopic surgery for FAI were accessed. Only studies that assessed the minimal MCID, PASS, SCB, and/or MIC were considered.</p><p><strong>Results: </strong>The methodological quality of the 21 included studies was assessed, and the overall risk of bias was found to be low-to-moderate. The main characteristics of the included studies were analyzed and summarized. In addition, we determined the MCID, PASS, SCB, and MIC of the hip injury and osteoarthritis outcome score (HOOS), short form 36 (SF-36), modified Harris hip score (mHHS), nonarthritic hip score (NASH), Copenhagen hip and groin outcome score (HAGOS), hip outcome score (HOS), international hip outcome tool-12 (iHOT-12), international hip outcome tool-33 (iHOT-33), University of California, Los Angeles Score (UCLA), visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for arthroscopic hip surgery.</p><p><strong>Conclusions: </strong>This systematic review provides clinically important outcome values, such as the MCID, PASS, SCB, and MIC, for the most commonly used PROMs in arthroscopic hip surgery, based on data from 21 studies involving 5687 patients. The calculated values for the MCID, PASS, SCB, and MIC could be helpful for future clinical trials investigating the outcomes of hip arthroscopy in patients with FAI. However, given the heterogeneity of the included studies, their predominantly nonrandomized designs, and differences in PROMs, follow-up intervals, and calculation methods, these findings should be interpreted with caution. Level of evidence Level IV, systematic review.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"27 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425537","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":"Development and validation of a deep learning model for radiographic classification of pediatric femoral neck fractures.","authors":"WenTao Wang, ShengHua He, LiHong Ou, Federico Canavese, Antonio Andreacchio, Chiara Arrigoni, Nunzio Catena, Marco Corradin, Mariabeatrice Damasio, Valentina Camurri, Francesco Candusso, Claudia De Cristo, Camilla De Luca, Sara De Salvo, Cristina Di Grigoli, Roberto Facchi, Andrea Florian, Cesare Gallo, Claudio Gargiulo, Rocco Grillo, Laura Giarratana, Emanuela Lanari, Veronica Lodovici, Giovanni Lucchesi, Ludovico Lucenti, Francesca Magnaguagno, Lorenza Marengo, Vittoria Mazzola, Angelo Musso, Luigi Aurelio Nasto, Vito Pavone, Andrea Pellegrino, Marco Ramella, Francesca Rizzo, Marco Sapienza, Nicola Stagnaro, Gianluca Testa, Andrea Vescio, XiaoLiang Chen, ChongZhi Zhao, DongKe Lai, Hang Liu, ChunXing Wu, ShunYou Chen, SuiGu Tang, QianQian Mei","doi":"10.1186/s10195-026-00953-3","DOIUrl":"10.1186/s10195-026-00953-3","url":null,"abstract":"<p><strong>Background: </strong>The Delbet-Colonna (DC) classification guides treatment of pediatric femoral neck fractures (PFNFs) but relies on clinical experience. No deep learning (DL) model has been developed and validated to differentiate between PFNFs and proximal femoral growth plates (PFGPs) and classify PFNFs via DC classification, in order to overcome this limitation.</p><p><strong>Materials and methods: </strong>X-ray data including the annotations of 5555 PFGPs, 1306 PFNFs with various DC types, and 257 pediatric subtrochanteric femoral fractures (PSFFs), were prepared to construct a DL model based on the you-only-look-once (YOLO) model with wavelet transform (WT) and attention mechanism (AM) architectures. Two senior-level pediatric orthopedic surgeons (POS) performed the annotations independently by referring to the postoperative X-rays. The annotations were finalized if there were no differences. Otherwise, the two POS discussed and determined the final annotation. Thirty-one POS with different experience assessed the external testing dataset twice, without (first) and with (second) YOLO-WTAM model assistance. The rating performances of the YOLO-WTAM model and POS were evaluated. The kappa value reflecting reliability was obtained using a Fleiss kappa analysis.</p><p><strong>Results: </strong>According to the internal testing dataset, the area under the curve for different annotations ranged from 0.94 to 0.99. According to the external testing dataset, in the second round, the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were greater than those in the first (P < 0.001): 79.17-87.16%, 83.30-87.47%, 94.68-96.57%, 74.62-79.44%, and 92.97-95.55%, respectively. Senior-level POS exhibited superior accuracy (P = 0.021), sensitivity (P = 0.013), specificity (P = 0.039), PPV (P = 0.004), and NPV (P = 0.025) in the first round but not in the second. The kappa value improved among residents (+27.36%), junior-level (+17.03%), mid-level (+26.66%), and senior-level (+17.07%) POS.</p><p><strong>Conclusions: </strong>The YOLO-WTAM model can accurately differentiate between PFNFs and PFGPs and classify different DC types of PFNFs. This improves POSs' rating performance and reduces the need for experience in classifying PFNFs.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413416","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":"Association between Kaplan fiber injury and anterolateral tibial subluxation in patients with anterior cruciate ligament injury.","authors":"Bailin Pan, Shangmin Chen, Yuanying Lin, Du Lin, Zhaohan Zhou, Bendan Lin, Laixi Zhou, Jinjin Ma, Xiaozhuan Wang, Chuangxin Lin","doi":"10.1186/s10195-026-00948-0","DOIUrl":"10.1186/s10195-026-00948-0","url":null,"abstract":"<p><strong>Background: </strong>Kaplan fibers (KFs) are critical stabilizers of the knee, yet their role in anterior tibial subluxation of the lateral compartment (ATSLC) in anterior cruciate ligament (ACL) injury remains unclear. This study is to determine whether KF injury is independently associated with increased ATSLC on magnetic resonance imaging (MRI) in patients with an injured ACL, and to identify risk factors for high-grade ATSLC (≥ 4.5 mm).</p><p><strong>Patients and methods: </strong>This retrospective study enrolled 132 patients with ACL injury who underwent MRI within 12 weeks of trauma. MRI was used to evaluate the integrity of the ACL, KFs, anterolateral ligament (ALL), bony morphology, and ATSLC. Two trained observers independently assessed all images using standardized criteria. Agreement between observers was calculated using standard reliability metrics. Multivariable linear regression was performed to evaluate the independent association between KF injury and ATSLC. Logistic regression and receiver operating characteristic analysis were used to identify predictors of high-grade anterior tibial subluxation (≥ 4.5 mm) in patients with combined ACL and anterolateral complex injuries.</p><p><strong>Results: </strong>Of the 132 patients, 35.6% had KF injuries. These patients exhibited higher rates of ALL injury and distinct bony morphologic features. KF injury independently explained 15.1% of anterior tibial subluxation variability (P < 0.001). In patients with combined anterolateral complex injuries, increased lateral femoral condyle width ratio was identified as an independent predictor of high-grade subluxation.</p><p><strong>Data conclusion: </strong>KF injury is independently associated with greater anterior tibial subluxation, suggesting a key role in post-traumatic knee instability. Specific femoral anatomical feature may further predict high-risk cases.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406524","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":"Fibrous dysplasia: clinical and pathologic characteristics, surgical approaches, and outcomes in a large Italian cohort.","authors":"Marina Mordenti, Giovanni Trisolino, Alice Moroni, Stefania Claudia Parisi, Susanna Nanni, Eric Lodewijk Staals, Alberto Righi, Marco Gambarotti, Davide Maria Donati, Luca Sangiorgi","doi":"10.1186/s10195-026-00947-1","DOIUrl":"10.1186/s10195-026-00947-1","url":null,"abstract":"<p><p>Fibrous dysplasia (FD) is a rare benign bone disease caused by postzygotic activating mutations in the GNAS gene, leading to replacement of normal bone with fibrous tissue. It may be monostotic or polyostotic, often asymptomatic but sometimes associated with pain, deformity, or fractures. Management is mainly surgical in symptomatic or complicated cases. This retrospective study analyzes a large FD cohort to identify determinants of treatment and outcomes, with a focus on pain and its evolution. The primary aim was to assess factors influencing surgical indication, while the secondary aim was to evaluate predictors of outcome in surgically treated patients, particularly symptom persistence at follow-up. A total of 227 patients were included. Mean age at diagnosis was 35.5 years (range 2-86 years); 79.3% had monostotic and 20.7% polyostotic FD. Pain was the most common presentation (62.6% at diagnosis; 78.4% during disease course), followed by incidental findings (21.6%), fractures (11.5%), and mass (4.4%). Surgery was performed in 51.6% of patients (127 lesions). Surgical patients were younger and had larger lesions and higher Mirels' scores (all p < 0.001), although Mirels' score showed only moderate predictive accuracy for surgery (area under the curve (AUC) 0.71). At a mean follow-up of 4.5 years, persistent pain was present in 24.1% of patients, with no significant difference between surgical and nonsurgical groups. Surgery was not an independent predictor of pain resolution in multivariable analysis. Postoperative complications occurred in 17.3% of procedures, with 7.1% requiring multiple revisions; rates were higher in polyostotic disease (21.3% versus 6.7%, p = 0.004). Our findings suggest that pain alone should not be used as an indication for surgery in FD, as it was not a reliable predictor of outcome in our study. Surgical decisions for pain relief should therefore be made with caution, and patients should be informed about the risk of persistent symptoms. Conservative, multidisciplinary management-including bisphosphonates, monoclonal antibodies, and psychological support-should be considered first-line, as it may improve symptoms and quality of life.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392251","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":"Glycemic variability improves risk prediction and reveals a mortality threshold in orthopedic trauma patients with sepsis.","authors":"Ze Long, Wei Wang, Shengjie Wang, Tao Han, Feng Lin, Feng Li, Yong Qin, Mingxing Lei","doi":"10.1186/s10195-026-00940-8","DOIUrl":"10.1186/s10195-026-00940-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis is a life-threatening complication in patients with orthopedic trauma, associated with significant mortality. Dysregulated glucose metabolism is a hallmark of critical illness, but the specific role of glycemic variability (GV), beyond hyperglycemia, in this high-risk population remains inadequately explored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study utilized 1946 patients from the Beth Israel Deaconess Medical Center between 2008 and 2022. We included adult intensive care unit (ICU) patients with a primary diagnosis of orthopedic trauma and concurrent sepsis. GV was quantified as the coefficient of variation of all blood glucose measurements during the ICU stay. The primary outcome was all-cause mortality at in-hospital, 30-day, 90-day, and 365-day. Restricted cubic spline (RCS) analysis was used to determine the detailed relationship between GV and mortality and the optimal GV threshold for dichotomization. Propensity score matching and multivariable logistic regression were employed to control for confounders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study cohort experienced substantial mortality, with rates of 16.0% (in-hospital), 19.8% (30-day), 26.4% (90-day), and 33.9% (365-day). RCS analysis revealed a significant nonlinear, J-shaped relationship between GV and all mortality end points (p &lt; 0.001), characterized by an initial modest increase in risk followed by a sharp escalation beyond a specific threshold. The optimal GV thresholds for predicting in-hospital, 30-day, 90-day, and 365-day mortality were remarkably consistent (0.218, 0.217, 0.205, and 0.210, respectively), leading to a unified average dichotomization threshold of 0.213. After propensity score matching created a well-balanced cohort, high GV remained independently associated with significantly increased risks of mortality across all time points in the fully adjusted model (adjusted odds ratio (OR) for in-hospital mortality: 1.969, 95% confidence interval (CI): 1.379-2.811, p &lt; 0.001; 30-day mortality OR: 1.744, 95% CI: 1.245-2.442, p = 0.001; 90-day mortality OR: 1.735, 95% CI: 1.268-2.375, p &lt; 0.001; 365-day mortality OR: 1.815, 95% CI: 1.352-2.438, p &lt; 0.001). Furthermore, adding GV significantly improved the predictive performance of the Oxford Acute Severity of Illness Score (OASIS) (area under the receiver operating characteristic curve (AUC) increased from 0.684 to 0.699 for in-hospital mortality, p = 0.008) and Charlson Comorbidity Index scores (AUC increased from 0.681 to 0.701, p = 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In critically ill septic patients with orthopedic trauma, elevated GV is a potent, independent predictor of short- and long-term mortality, exhibiting a J-shaped relationship with mortality risk. GV values above 21.3% are associated with significantly higher mortality risk, and this threshold may serve as a useful prognostic marker for risk stratification. Furthermore, GV provides incremen","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370251","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":"Thicker polyethylene inserts for varus deformity versus thinner inserts for flexion contracture in total knee arthroplasty: a retrospective comparative study.","authors":"Seung-Hun Lee, Hyuck Min Kwon, Woo-Suk Lee, Kwan Kyu Park","doi":"10.1186/s10195-026-00939-1","DOIUrl":"10.1186/s10195-026-00939-1","url":null,"abstract":"<p><strong>Background: </strong>The success of total knee arthroplasty (TKA) depends on achieving precise mechanical alignment and stable soft tissue balance, with the thickness of the final polyethylene (PE) insert serving as a critical component. However, the impact of preoperative factors on PE thickness remains unclear. In this study, we investigated the effects of preoperative knee alignment and clinical deformities on PE thickness.</p><p><strong>Materials and methods: </strong>The medical records of patients who underwent primary TKA between August 2024 and July 2025 were retrospectively evaluated. Preoperative radiographic parameters, including the hip-knee-ankle (HKA) angle, medial proximal tibial angle, lateral distal femoral angle (LDFA), joint-line convergence angle, weight-bearing line ratio (WBLR), and posterior tibial slope, were measured, along with the flexion contracture (FC) as a clinical factor. Intra-observer reliability was assessed using intraclass correlation coefficients (ICC). Linear regression analyses were performed to evaluate the effects of these preoperative factors on PE thickness.</p><p><strong>Results: </strong>This study included 233 knees (158 patients). The intra-observer reliability of the radiographic parameters was excellent (ICC > 0.9). Multivariable linear regression revealed that preoperative HKA angle (β = 0.033, p < 0.001), WBLR (β = -0.008, p < 0.001), and LDFA (β = 0.065, p = 0.003) were significantly associated with final PE thickness. Preoperative FC demonstrated a significant negative correlation (β = -0.027, p = 0.011). In a subgroup analysis of knees with minimal FC, the mean PE thickness increased from 10.37 mm in mild varus to 12.75 mm in extreme varus.</p><p><strong>Conclusions: </strong>Preoperative HKA angle and FC were identified as significant predictors of PE insert thickness in TKA. Specifically, greater varus deformity resulted in a thicker PE insert, whereas more severe FC led to a thinner insert. Clinically, surgeons must anticipate gap expansion after medial release in varus knees, while accommodating the tight extension space in the FC. Level of evidence Level III, retrospective comparative study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320022","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":"Fibular allograft augmentation shows potential benefits in treating medial column comminuted proximal humeral fractures with osteoporosis: a secondary analysis of a randomized controlled trial.","authors":"Yijie Chai, Tingwang Shi, Haochen Jiang, Yujie Chen, Zhengliang Xu, Yu Zhu, Zesong Ruan, Yunfeng Chen, Qiuke Wang","doi":"10.1186/s10195-026-00934-6","DOIUrl":"10.1186/s10195-026-00934-6","url":null,"abstract":"<p><strong>Background: </strong>Fibular allograft (FA) augmentation is proposed to address the lack of medial column support in plate-fixed proximal humeral fractures; however, the role of FA augmentation in these fractures remains inadequately elucidated. Our previous clinical trial did not show additional benefit in inserting an FA when treating adults with medial column comminuted proximal humeral fractures. Nonetheless, it is possible that some subgroups may still derive benefits from FA. This study aimed to investigate whether there were any subgroups benefit from FA.</p><p><strong>Materials and methods: </strong>Our randomized controlled trial (RCT) recruited adults with a medial column comminuted proximal humeral fracture and randomly allocated them to receive a surgery fixed with a locking plate (LP group) or with an LP augmented with an FA (FA group). This study was a subsequent subgroup analysis of the previous randomized controlled trial, in which we included 72 participants who completed follow-up at the time of 12 months for the current subgroup analysis. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months postoperatively. The secondary outcomes included the DASH score at other time points, changes in neck-shaft angle and humeral head height. We used generalized linear models for subgroup analysis to evaluate the effect of intervention (FA or LP) on 12-month DASH score in subgroups.</p><p><strong>Results: </strong>A total of 72 participants who completed follow-up at 12 months were included: 35 were in the FA group and 37 in the LP group. In participants with proximal humeral osteoporosis, both the unadjusted mean difference (-12.8; 95% confidence interval (CI) -22.2 to -3.2; p = 0.01) and the adjusted mean difference (-11.1; 95% CI -20.0 to -2.2; p = 0.02) in the 12-month DASH score were statistically significant. Furthermore, in proximal humeral osteoporosis category, the DASH scores at other time points showed the similar trends though did not reach statistical significance.</p><p><strong>Conclusions: </strong>FA augmentation seemed to have added values in treating osteoporotic proximal humeral fractures in combination with medial column comminution.</p><p><strong>Level of evidence: </strong>Level II, therapeutic study.</p><p><strong>Trial registration: </strong>ChiCTR-IOR-16008817.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333751","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":"PediLoc^® blade plate yields faster consolidation rates than LCP pediatric condylar plate in distal femoral osteotomies: a retrospective comparison and description of surgical technique.","authors":"Samuel Tschudi, Cyrill Delay, Britta Krautwurst, Domenic Grisch, Thomas Dreher","doi":"10.1186/s10195-026-00946-2","DOIUrl":"10.1186/s10195-026-00946-2","url":null,"abstract":"<p><strong>Background: </strong>The PediLoc^® Locking Cannulated Blade Plate System was originally designed for proximal femoral osteotomies but has also been used for multidimensional correction of distal femoral deformities. The present study delineates the surgical technique and undertakes a retrospective analysis of the consolidation rates of distal femoral osteotomies performed using the aforementioned system, comparing them with those performed using the DePuy Synthes^® 90° LCP Pediatric Condylar Plate. We hypothesized that the semi-rigid design of the blade plate results in faster osteotomy healing rates compared with other locking screw plate systems.</p><p><strong>Materials and methods: </strong>This retrospective single-centre study included patients who underwent distal femoral osteotomy with the PediLoc^® Blade Plate (Blade Plate) and the DePuy Synthes^® 90° LCP Pediatric Condylar Plate (90° LCP-PCP) at the University Children's Hospital Zurich (2020-2024). Consolidation rates were assessed using \"Regenerating Bone Defects Using New Biomedical Engineering\" (REBORNE), \"Radiographic Union Score for Tibial Fractures\" (RUST) and modified RUST (mRUST) scores at 6 weeks and 3 months postoperatively and compared using using Wilcoxon signed-rank test. For the comparison between both intervention groups, the unpaired t-test was used for normally distributed data and the Mann-Whitney U test for non-normally distributed and ordinal data. For all tests, values of p < 0.05 were considered statistically significant. Geometric planes of osteotomy were analysed, and a stepwise correction technique was described.</p><p><strong>Results: </strong>A total of 111 osteotomies with complete radiographic follow-up were analysed (77 Blade Plate [69.4%], 34 90° LCP-PCP [30.6%]). At 6 weeks, early consolidation (RUST score ≥ 10) was observed in 39% of Blade Plate cases versus 6% in the 90° LCP group. By 3 months, consolidation reached 91% in the Blade Plate group and 70% in the 90° LCP-PCP group. One Blade Plate case was excluded due to an implant-associated intraoperative fracture.</p><p><strong>Conclusions: </strong>The PediLoc^® Blade Plate facilitates stable, multidirectional correction of distal femoral deformities and achieves earlier radiographic consolidation of osteotomies compared with the 90° LCP-PCP without increased complication rates. Since faster consolidation was observed only in the RUST scores, the clinical relevance of this finding remains to be determined through prospective randomized controlled trials.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov, 2025-0000, registration date 14 April 2025, retrospectively registered, https://register.</p><p><strong>Clinicaltrials: </strong>gov/prs/beta/records.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310092","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":"Thin cortical translucent area of the iliac wing: morphometric analysis and implications for surgical safety.","authors":"Helin Yücedağ Gündoğdu, Bahattin Paslı, Burcu Erçakmak Güneş","doi":"10.1186/s10195-026-00944-4","DOIUrl":"10.1186/s10195-026-00944-4","url":null,"abstract":"<p><strong>Background: </strong>The iliac wing is a frequently used fixation site in the surgical management of pelvic and acetabular fractures. Achieving safe implant placement in this region necessitates a comprehensive understanding of local morphology. However, the morphometric characteristics and surgical safety margins of the thin cortical translucent area (PLA) located in the central iliac wing have not been sufficiently defined. This may pose a significant challenge in evaluating the risk of cortical perforation, particularly during implant placement. This study aimed to evaluate the morphometric characteristics of the PLA and its relationship to fixation corridors.</p><p><strong>Methods: </strong>Fifty-one unpaired dry hip bones were examined. The thin cortical translucent region was identified using photoluminescence. Photograph-based measurements were conducted utilising ImageJ software on standardised photographs. Dimensions, area, distances to reference landmarks and relationships with the iliac pillar and supraacetabular corridors were assessed. The safe angular deviation range for anterior inferior iliac spine (AIIS)-origin screw fixation was calculated. Cortical thickness was measured using a digital thickness gauge.</p><p><strong>Results: </strong>The vertical and horizontal diameters and area of the PLA were 56.24 ± 16.56 mm, 59.92 ± 24.83 mm and 28.10 ± 16.47 cm², respectively. Mean distances to the anterior superior iliac spine, posterior superior iliac spine, iliac crest and acetabular roof were 62.12 ± 19.84 mm, 71.03 ± 12.17 mm, 19.88 ± 11.61 mm and 56.02 ± 9.09 mm, respectively. The safe angular deviation for AIIS-origin screw fixation was 16.94° ± 4.43°. The central cortical thickness was 2.07 ± 1.60 mm (range 0.3-5.9).</p><p><strong>Conclusions: </strong>The PLA is a clinically important region characterised by marked central cortical thinning and individual variability. Individualised morphometric assessment and preoperative imaging may help define safer zones for fixation planning and donor-site procedures.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273470","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":"Efficacy and safety of MIPO versus ORIF in distal tibial fractures: a systematic review and meta-analysis.","authors":"Ahmed Mohamed Hassaan, Atef A Hassan, Waleed Said Abdelkhalik, Ahmed Mostafa Saad, Amr Sayed Hosny, Bassem Abd Elmottaleb Hamid Elfeky, Ibrahim Mandour, Mohamed Gad Ragheb, Mahmoud Abd El Aliem Elsayyad, Mohamed Abdo Khalafalla, Mohamed A Imam","doi":"10.1186/s10195-026-00938-2","DOIUrl":"10.1186/s10195-026-00938-2","url":null,"abstract":"<p><strong>Background: </strong>Distal tibial fractures are challenging to manage owing to limited soft-tissue coverage and compromised blood supply. Minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) are among the widely used surgical options, but the optimal approach remains unclear. MIPO preserves periosteal blood flow with smaller incisions, while ORIF offers direct visualisation but increases soft-tissue damage. With growing comparative evidence, an updated evaluation of these techniques is necessary.</p><p><strong>Aim: </strong>To compare the efficacy and safety of MIPO versus ORIF in adult patients with distal tibial fractures.</p><p><strong>Methods: </strong>Following PRISMA guidelines and the Cochrane Handbook, we searched in PubMed, Embase, Cochrane, Scopus, and Web of Science till November 2025. Randomised trials and cohort studies comparing MIPO and ORIF were included. Data extraction was performed independently by two reviewers. Risk of bias was assessed using RoB 2 for RCTs and the Newcastle-Ottawa Scale for observational studies. Random-effects models were used to estimate pooled mean differences and odds ratios, and heterogeneity was assessed using I². Sensitivity and subgroup analyses were conducted by study design.</p><p><strong>Results: </strong>Nine studies involving 530 patients met our inclusion criteria. No significant differences were found between MIPO and ORIF in AOFAS scores, union time, operative duration, hospital stay, return-to-work time, or major complications. MIPO showed trends toward shorter union time, reduced blood loss, and lower infection rates. Infection analysis showed a nonsignificant odds ratio (OR 0.57; 95% CI 0.24-1.33) but a statistically significant risk difference (RD -0.06; 95% CI -0.11 to -0.01), reflecting an absolute reduction of 4.6% with MIPO. Rates of malunion, delayed union, nonunion, and wound complications were similar between groups.</p><p><strong>Conclusions: </strong>MIPO and ORIF provide comparable functional and radiological outcomes for distal tibial fractures. MIPO offers modest advantages in soft-tissue preservation and infection risk. Surgical choice should be individualized on the basis of fracture characteristics and soft-tissue condition. Further multicenter randomized trials are needed.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13283236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266714","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}