Journal of Orthopaedics and Traumatology最新文献

{"title":"Feasibility of non-radical resection combined with internal fixation for adolescents with lower limb fibrous dysplasia: a single-center retrospective study with a small sample size.","authors":"Yang Li, Dong Sun, Zhihang Zhou, Xintao Zhang, Aiwu Li, Junfei Chen","doi":"10.1186/s10195-025-00838-x","DOIUrl":"https://doi.org/10.1186/s10195-025-00838-x","url":null,"abstract":"<p><strong>Background: </strong>The management of osteofibrous dysplasia (OFD) is controversial, with limited reports on combining non-radical resection with internal fixation. This study evaluates optimal treatments for patients with OFD aged < 15 years, with attention to the limitations of the small sample size.</p><p><strong>Materials and methods: </strong>This retrospective analysis included 28 patients (30 extremity) with severe pain, pathological fractures, angular deformities, or extensive cortical bone involvement. On the basis of the surgical approach, patients were divided into four groups: group 1, curettage, allograft, and plate fixation for six patients (six extremity); group 2, elastic stable intramedullary nailing fixation for six patients (six extremity); group 3, Fassier-Duval telescopic system fixation for eight patients (nine extremity); and group 4, interlocking intramedullary nail for eight patients (nine extremity).</p><p><strong>Results: </strong>All patients achieved bony union and pain alleviation with no recurrence of deformities. The refracture rate during the follow-up was zero cases (0%; group 1) versus one (16.7%; group 2) versus zero (0%; group 3) versus zero cases (0% group 4) (p > 0.05). Instances of internal fixation loosening were zero cases (0%; group 1) versus zero (0%; group 2) versus five (55.6%; group 3) versus zero cases (0%; group 4) (p < 0.05). The musculoskeletal tumor society (MSTS) scores of the four groups were 27.5 (group 1) versus 27.7 (group 2) versus 26.3 (group 3) versus 28.7 (group 4) (p < 0.05).</p><p><strong>Conclusions: </strong>Selecting different treatment strategies for patients of various ages and locations with OFD is vital. Surgical intervention for patients with persistent pain, pathological fractures, extensive cortical bone involvement, or significant tibial deformities can significantly improve their quality of life. The encouraging MSTS scores also support this conclusion. However, given the study's single-center design and small sample size, further research with larger, multicenter studies is necessary.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"24"},"PeriodicalIF":3.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12031686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application of antibiotic-loaded bone cement in preventing periprosthetic joint infection: an umbrella review.","authors":"Yangbin Cao, Peiyuan Tang, Hua Chai, Wenbo Ma, Bin Lin, Ying Zhu, Ahmed Abdirahman, Wenfeng Xiao, Jun Zhang, Yusheng Li, Shuguang Liu, Ting Wen","doi":"10.1186/s10195-025-00839-w","DOIUrl":"https://doi.org/10.1186/s10195-025-00839-w","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to provide thorough, understandable and precise evidence for the clinical use of antibiotic-loaded bone cement (ALBC) in preventing periprosthetic joint infection (PJI).</p><p><strong>Methods: </strong>We evaluated the effectiveness of ALBC in preventing PJI by conducting an umbrella review of existing meta-analysis. Four databases, PubMed/MEDLINE, Cochrane Library, Embase and Web of Science, were searched until May 2024. Two reviewers were reviewers for literature screening, and data were extracted independently. AMSTAR 2 guideline and GRADE were also used for quality evaluation. The clinical outcomes were evaluated for effectiveness by several indicators, including surface infection rate (SIR), deep infection rate (DIR), total infection rate (TIR), unadjusted/adjusted all-cause revision rate, and revision rate for PJI.</p><p><strong>Results: </strong>We synthesized the results of ten meta-analyses. Two meta-analyses had high AMSTAR 2 scores, two had moderate AMSTAR 2 ratings, three had critically low AMSTAR 2 scores, and the remaining meta-analyses had low AMSTAR 2 ratings. In terms of postoperative surgical site infection and revision rate, SIR (OR 1.50, 95% CI 1.14, 1.99, P = 0.004, I² = 0%), unadjusted all-cause revision rate (RR 1.44, 95% CI 1.08, 1.90, P = 0.011, I² = 91.8%) and adjusted all-cause revision rate (HR 1.21, 95% CI 1.12, 1.31, P < 0.001, I² = 0%) in ALBC group were significantly higher than those in non-antibiotic-loaded bone cement (NALBC) group. ALBC group was significantly lower than NALBC group in DIR (OR 0.53, 95% CI 0.39, 0.70, P < 0.0001, I² = 57%), (RR 0.506, 95% CI 0.341, 0.751, P = 0.001, I² = 0%) and revision for PJI (RR 0.721, 95% CI 0.628, 0.828, P = 0, I² = 53%). There was no statistical difference in total infection rate (TIR) between the ALBC group and the NALBC group (OR 0.81, 95% CI 0.51, 1.28, P = 0.37, I² = 73%).</p><p><strong>Conclusions: </strong>On the basis of the results of our analysis, we do not believe that ALBC is more effective than NALBC in preventing PJI after primary total joint arthroplasty (PTJA). No statistically significant difference was found on TIR between the two groups, although it was lower in the ALBC group. In addition, the DIR and revision for PJI are significantly lower in the ALBC group, but the results are of low quality, which calls for high-quality and large-sample studies in the future.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"23"},"PeriodicalIF":3.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12008095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988714","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":"Double plating versus nail-plate construct in AO 33C distal femur fractures: treatment choice affects knee alignment, clinical outcomes, and quality of life-a multicenter study.","authors":"Domenico De Mauro, Amarildo Smakaj, Alessandro Casiraghi, Claudio Galante, Federico Bove, Mario Arduini, Giovanni Vicenti, Francesco Addevico, Abramo Fratus, Nicola Macellari, Matteo Caredda, Claudio Buono, Giulio Maccauro, Giuseppe Rovere, Francesco Liuzza","doi":"10.1186/s10195-025-00834-1","DOIUrl":"10.1186/s10195-025-00834-1","url":null,"abstract":"<p><strong>Background: </strong>Distal femur fractures present a significant challenge for orthopedic surgeons, accounting for approximately 5% of all femoral fractures. Among the most commonly reported combined techniques in the literature are the double-plate technique and the retrograde nailing plus lateral plating, the nail-plate construct (NPC). The aim of our study is to compare surgical data, quality of life, and functional outcomes in 33-C fractures treated with either double-plate constructs or a retrograde nailing plus lateral plate.</p><p><strong>Materials and methods: </strong>A multicenter retrospective observational study was conducted in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Diagnoses were made on the basis of the AO classification, utilizing traditional radiological assessments. Patients were categorized into two groups on the basis of the surgical treatment they received: The NPC group comprised patients who underwent surgery with nail-plate construct, while the Plate group consisted of those who had surgery with double plating.</p><p><strong>Results: </strong>A total of 42 patients were included in the study. The NPC group comprised 26 patients with a mean age of 58.4 ± 18.8 years, while the Plate group consisted of 16 patients with a mean age of 61.3 ± 16.4 years. Significant differences were observed in knee extension recovery (p = 0.010) and lateral distal femur angle (LDFA) (p < 0.001). Linear regression showed a significant influence from treatment choice on all the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, as well as in all domains of the European Quality of Life Five Dimensions Five-Level Version (EQ-5D-5L), except for the Daily Self-Care domain.</p><p><strong>Conclusions: </strong>Nail-plate constructs seems to lead to significantly better outcomes in AO type C distal femur fractures, compared with double plating, in terms of knee function and quality of life. Significant differences are shown also in anatomical outcomes, especially in extension gap, and LDFA.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"22"},"PeriodicalIF":3.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774553","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":"It is not waste if it is therapy: cellular, secretory and functional properties of reamer-irrigator-aspirator (RIA)-derived autologous bone grafts.","authors":"S Häusner, A Kolb, K Übelmesser, S Hölscher-Doht, M C Jordan, A Jauković, F Berberich-Siebelt, D V Spasovski, J Groll, T Blunk, M Herrmann","doi":"10.1186/s10195-025-00835-0","DOIUrl":"10.1186/s10195-025-00835-0","url":null,"abstract":"<p><strong>Background: </strong>Large bone defects resulting from trauma, disease, or resection often exceed the intrinsic capacity of bones to heal. The current gold standard addressing these defects is autologous bone grafting (ABG). Procedures such as reamer-irrigator-aspirator (RIA) and conventional bone grafting from the iliac crest are widely recognized as highly effective interventions for critical-size bone defects. The early phase of fracture healing is particularly crucial, as it can determine whether a complete bony union occurs, or if delayed healing or non-unions develop. The initial composition of the bone marrow (BM)-rich ABG transplant, with its unique cellular (e.g., leukocytes, monocytes, and granulocytes) and acellular (e.g., growth factors and extracellular proteins) components, plays a key role in this process. However, despite many successful case reports, the role of ABG cells, growth factors, and their precise contributions to bone healing remain largely elusive.</p><p><strong>Materials and methods: </strong>We characterized the native cellularity of both solid and liquid RIA-derived ABG by analyzing primary, minimally manipulated populations of monocytes, macrophages, and T cells, as well as hematopoietic, endothelial, and mesenchymal progenitor cells by flow cytometry. Growth factor and cytokine contents were assessed through antibody arrays. Possible functional and immunomodulatory properties of RIA liquid were evaluated in functional in vitro assays.</p><p><strong>Results: </strong>Growth factor and protein arrays revealed a plethora of soluble factors that can be linked to specific immunomodulatory and angiogenic properties, which were evaluated for their potency using functional in vitro assays. We could demonstrate a strong M2-macrophage phenotype inducing the effect of RIA liquid on macrophages. Additionally, we observed an increase in anti-inflammatory T cell subsets generated from peripheral blood mononuclear cells and BM mononuclear cells upon stimulation with RIA liquid . Finally, in vitro endothelial tube formation assays revealed highly significant angiogenic properties of RIA liquid, even at further dilutions.</p><p><strong>Conclusion: </strong>The cytokine and protein content of RIA liquid exhibits potent immunomodulatory and angiogenic properties. These findings suggest significant therapeutic potential for RIA liquid in modulating immune responses and promoting angiogenesis. Anti-inflammatory and angiogenic properties demonstrated in this study might also help to further define and understand its particular mode of action while also providing explanations to the excellent bone-healing properties of ABG in general.</p><p><strong>Level of evidence: </strong>Case-series (Level 4).</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"21"},"PeriodicalIF":3.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722078","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":"Ultra-distal tibial fractures: a retrospective comparison of distal plate versus nail fixation.","authors":"Feng Wang, Xiaoshu Zhu, Xiangyang Dai, Lei Wang, Chengpu Zhong, Jian Qin, Tangbo Yuan","doi":"10.1186/s10195-025-00832-3","DOIUrl":"10.1186/s10195-025-00832-3","url":null,"abstract":"<p><strong>Background: </strong>Current literature on ultra-distal tibial fractures (UDTF) is relatively limited, particularly regarding the outcomes and complications of different treatment strategies, with data being notably scarce. This study aimed to compare the clinical outcomes of intramedullary nailing (IMN) and distal tibial plate (DTP) fixation in the treatment of UDTF.</p><p><strong>Methods: </strong>A total of 48 eligible patients were retrospectively reviewed and divided into two matched groups based on age, gender, injury severity score, and fracture type. The IMN group comprised 21 patients, and the DTP group included 27 patients. All patients were followed up to assess both clinical and radiological outcomes.</p><p><strong>Results: </strong>The IMN group demonstrated significantly shorter surgery time (P = 0.043) and fracture healing time (P = 0.002) compared with the DTP group. However, no significant differences were found between the two groups in terms of time from fracture to admission (P = 0.740), preoperative hospital stay (P = 0.310), postoperative hospital stay (P = 0.379), infection rates (P = 1.000), or rates of nonunion (P = 0.822). Postoperative malalignment occurred in three patients in the IMN group and one patient in the DTP group (P = 0.430). The mean postoperative angulation in both groups was similar in the coronal plane (P = 0.101) and sagittal plane (P = 0.334). The mean Olerud-Molander Ankle Score (OMAS) was 88.62 ± 5.24 in the IMN group and 85.85 ± 8.39 in the DTP group (P = 0.169).</p><p><strong>Conclusion: </strong>Both implants are effective in treating UDTF. However, IMN offers advantages in reducing surgical time, accelerating fracture healing, and promoting early recovery. Therefore, IMN may represent a superior surgical option for managing UDTF.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"20"},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671499","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 head osteotomy: A new technique for better exposure of postero-lateral tibial plateau fracture.","authors":"Shaozheng Yang, Yong Lian, Li Yang, Sushuang Ma, Chao Ding, Feng Huang, Yongqiang Liu, Heng Li, Zhu Mutan, Hua Zhong, Hongfen Chen","doi":"10.1186/s10195-025-00836-z","DOIUrl":"10.1186/s10195-025-00836-z","url":null,"abstract":"<p><strong>Objective: </strong>Various osteotomy techniques have been explored for exposing the posterolateral tibial plateau in previous studies. However, these methods are often complex, cause significant damage to normal anatomical structures, compromise knee joint stability, and pose risks to knee function, thus limiting their clinical application. This study proposes a new fibular head osteotomy technique for treating posterolateral tibial plateau fractures, aiming to achieve favorable surgical outcomes.</p><p><strong>Methods: </strong>Thirteen patients who underwent surgical treatment for posterolateral tibial plateau fractures between March 2020 and August 2023 at our hospital were included in this study. The study was approved by the clinical ethics committee of our institution. All patients provided informed consent before participation. Surgeries were performed through a modified Frosch approach combined with partial fibular head osteotomy, while preserving part of the biceps femoris tendon attachment to the fibula. Postoperative fracture reduction quality was assessed using X-rays and computed tomography (CT) scans, in accordance with the Rasmussen radiology scoring system. Knee joint function was evaluated at the final follow-up using the Hospital for Special Surgery (HSS) scoring system. The healing of the fibular head osteotomy site and the presence of any complications were also assessed.</p><p><strong>Results: </strong>All 13 patients were followed up with for an average of 12.2 months (range: 9-17 months). All fractures, collapse, and deformities were corrected. The mean Rasmussen radiological score was 15.5 ± 2.5 (range: 10-18), with four cases rated as excellent, eight as good, and one as fair. The mean Hospital for Special Surgery (HSS) score was 89.8 ± 6.4 (range: 78-98), with 10 cases rated as excellent and 3 as good. No posterolateral knee instability was observed during physical examination at the final follow-up. There were no complications such as surgical site infection or common peroneal nerve injury.</p><p><strong>Conclusions: </strong>Partial fibular head osteotomy combined with preservation of the biceps femoris tendon attachment is an effective technique for treating posterolateral tibial plateau fractures. This method allows for successful fracture reduction and fixation without compromising knee joint function.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"19"},"PeriodicalIF":3.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665164","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":"Nomogram to predict periprosthetic joint infection after total hip arthroplasty using laboratory tests.","authors":"Junzhe Lang, Zetao Dong, Boyuan Shi, Dongdong Wang, Jiandong Yuan, Lei Chen, Jianqing Gao, Anan Sun, Jiyue Huang, Zhiqiang Xue","doi":"10.1186/s10195-025-00833-2","DOIUrl":"10.1186/s10195-025-00833-2","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) is a catastrophic complication after joint arthroplasty. This study aimed to analyze the relationship between laboratory tests and PJI and establish a nomogram for predicting risks of PJI after total hip arthroplasty (THA).</p><p><strong>Materials and methods: </strong>The clinical data of patients who underwent THA from January 2015 to December 2020 were retrospectively analyzed. Demographic and relevant clinical information of patients was collected; independent risk factors associated with PJI were determined by univariate and multivariate logistic regression analysis, and receiver operating characteristics (ROC) were drawn to analyze the specificity and sensitivity of each risk factor. Risk factors are included in the nomogram. Calibration curve and decision curve analysis were used to evaluate the predictive accuracy and discriminability of the model.</p><p><strong>Results: </strong>A total of 589 patients were enrolled in the study, of whom 87 were eventually diagnosed with PJI. Multivariate logistic regression analysis showed that serum C-reactive protein, erythrocyte sedimentation rate, polymorphonuclear neutrophils, D-dimer, and platelet count were independent risk factors for PJI after THA. The ROC curve analysis model of multivariate combined diagnosis had good diagnostic value, sensitivity was 77.01%, and specificity was 75.51%. The calibration curve shows good agreement between the prediction of the line graph and the actual observed results. The decision curve shows that the nomogram has a net clinical benefit.</p><p><strong>Conclusions: </strong>The changes in serum C-reactive protein, erythrocyte sedimentation rate, polymorphonuclear neutrophils, D-dimer, and platelet count are related to the occurrence of PJI after hip arthroplasty. The nomogram prediction model established in this study is promising for the screening of PJI after hip arthroplasty.</p><p><strong>Level of evidence: </strong>Level III evidence. Non-randomized controlled cohort/follow-up study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"18"},"PeriodicalIF":3.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665167","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":"Female patients report comparable results to males after the implantation of an aragonite-based scaffold for the treatment of knee chondral and osteochondral defects: a gender-based analysis of a RCT at 4 years' follow-up.","authors":"Elizaveta Kon, Francesca De Caro, Vinod Dasa, Jason M Scopp, Berardo Di Matteo, David Flanigan, Nogah Shabshin, Sabrina Strickland, Nir Altschuler","doi":"10.1186/s10195-025-00829-y","DOIUrl":"10.1186/s10195-025-00829-y","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to provide a gender-based analysis of the results of a large, multi-centre randomized controlled trial (RCT) comparing a novel cell-free aragonite-based scaffold with the standard of care (i.e. debridement/microfractures) for the treatment of chondral/osteochondral defects in knees with or without concurrent osteoarthritis.</p><p><strong>Materials and methods: </strong>A total of 251 patients were included: 167 patients in the scaffold group and 84 in the control. In the scaffold group, there were 105 males and 59 females, whereas the control group consisted of 51 males and 32 females. Patients were evaluated up to 48 months after the treatment. The primary endpoint was the change from baseline to 48 months in the KOOS overall score. Treatment failures were defined as any secondary invasive intervention, including intra-articular injection or any surgery in the treated joint. All patients underwent magnetic resonance imaging (MRI) at 12 and 24 months to assess the percentage of defect fill after surgery.</p><p><strong>Results: </strong>Both males and females in the scaffold group achieved significantly better results than controls in any KOOS subscale, as well as in KOOS overall, up to the final 48 months follow-up. Outcomes reported by females were non-inferior to those of males in the implant group. At 24 months' MRI evaluation, 86.2% of male patients in the scaffold group presented at least 75% defect fill compared with 32.6% in the control group. In the scaffold group, 87.6% of female patients presented at least 75% defect fill, compared with 28% in the control group (p < 0.0001 in both cases). Responders' rate and failure rate were also significantly better in the scaffold group for both males and females.</p><p><strong>Conclusion: </strong>The aragonite scaffold outperformed the control group at 48 months' evaluation. The gender-based analysis proved that males and females in the scaffold group presented comparable clinical and radiographical results, both significantly better than their counterparts treated by debridement/microfractures.</p><p><strong>Level of evidence: </strong>I-Randomized controlled trial.</p><p><strong>Trial registration: </strong>Clinicaltrial.gov ID: NCT03299959 (registered on 14 September 2017).</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"17"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626526","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":"Endoscopic-assisted percutaneous fixation for displaced anterior inferior iliac spine avulsion fractures: a prospective cohort study.","authors":"Andrea Audisio, Alessandro Aprato, Virginia Reinaudo, Giuseppe Sinatra, Lorenzo Lucchino, Alessandro Massè","doi":"10.1186/s10195-025-00831-4","DOIUrl":"10.1186/s10195-025-00831-4","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior inferior iliac spine (AIIS) avulsion fractures commonly occur in adolescent patients during sports activities. To systematically evaluate fracture severity and guide management, an adaptation of the Hetsroni classification system was used to categorize fractures on the basis of their displacement relative to the acetabular rim. Traditional open reduction and internal fixation reported satisfactory consolidation rates but complications such as lateral femoral cutaneous nerve (LFCN) neuropathies, heterotopic ossifications (HO), and subspine impingement. The objectives of this work are to (1) report short- and mid-term radiographic and clinical outcomes and (2) propose an adapted classification system based on the risk of subsequent subspine impingement.</p><p><strong>Materials and methods: </strong>A prospective cohort study was conducted on patients with AIIS avulsion fracture with ≥ 1.5 cm displacement who underwent surgery between 2021 and 2024. Patients with follow-up < 6 months, displacement < 1.5 cm, comminuted fractures, or chronic fractures were excluded. Clinical outcomes, including the subspine impingement test, the modified Harris Hip Score (mHHS), and the University of California Los Angeles Score (UCLA), were evaluated at last follow-up. Postoperative complications, such as LFCN neurapraxia, HO (classified by Brooker), and surgical revisions, are reported.</p><p><strong>Results: </strong>Eleven male patients with mean age of 14.1 years (range 12.8-15.0 years) were included. Fractures were classified as type I in two patients (18.2%), type II in four patients (36.4%), and type III in five patients (45.4%). The mean surgical duration was 71.4 min (SD 17.1 min), and the average time from injury to surgery was 4.2 days (range 1-11 days). The mean fracture displacement was 18.3 mm (range 15-25 mm). Postoperative scores averaged 89.7 for mHHS (SD 3.1) and 9.7 for UCLA (SD 0.6). Patients were followed for 20.0 months (range 6-47 months, SD 13.3 months). One patient underwent open surgical revision and subsequently experienced temporary LFCN neurapraxia, HO (Brooker 1), and symptoms of subspine impingement.</p><p><strong>Conclusions: </strong>Endoscopic-assisted percutaneous fixation is an effective technique for treating displaced AIIS avulsion fractures. Preliminary results suggest that this approach offers noninferior results, satisfactory outcomes, and limited complications. Further studies with long-term follow-up are needed to confirm these findings.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"16"},"PeriodicalIF":3.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587588","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":"Effects of intra-articular tranexamic acid injection with different acting times after anterior cruciate ligament reconstruction: a cohort study with historical controls.","authors":"Kun-Han Lee, Kun-Hui Chen, Hsuan-Hsiao Ma, Tai-Jung Huang, Hsiao-Li Ma, En-Rung Chiang","doi":"10.1186/s10195-025-00826-1","DOIUrl":"10.1186/s10195-025-00826-1","url":null,"abstract":"<p><strong>Background: </strong>Intra-articular tranexamic acid (TXA) has been proven effective in reducing postoperative bleeding in anterior cruciate ligament reconstruction (ACLR). We aimed to evaluate the effect of intra-articular injection of TXA with different acting times after an ACLR procedure.</p><p><strong>Patients and methods: </strong>Patients receiving ACLR and intra-articular injection of TXA between September 2023 and January 2024 were randomly divided into two groups, with drainage clamped for 4 h (TXA 4 h group) or 8 h (TXA 8 h group). Postoperative drainage output was the primary outcome. The secondary outcomes included the visual analog scale (VAS), grade of hemarthrosis, and International Knee Documentation Committee (IKDC) functional score. The data of another two groups of patients (TXA 2 h group and placebo group) were retrieved from a previous study as historical control groups for subsequent analysis.</p><p><strong>Results: </strong>121 patients were included. There were no significant differences in drainage output between TXA 4 h and TXA 8 h groups. On postoperative day 3, significantly decreased grades of hemarthrosis were noted in the TXA 8 h group (P = 0.030). There were no significant differences in the VAS at different postoperative time points or in the IKDC scores. Comparison with the placebo and TXA 2 h groups revealed significant reduction in postoperative drainage among the TXA 4 h and 8 h groups. The IKDC scores were significantly worse in the TXA 8 h group compared with the TXA 2 h (P < 0.001) and placebo (P = 0.009) groups.</p><p><strong>Conclusions: </strong>A 4 h clamping time for intra-articular TXA administration after ACLR may be considered in current practice, as it effectively reduces drainage and pain without negatively impacting functional outcomes.</p><p><strong>Level of evidence: </strong>Level III, cohort study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"15"},"PeriodicalIF":3.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582386","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}