Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Using the Score for Trauma Triage for Geriatric and Middle-aged (STTGMA) to Cluster High-Risk Hip Fracture Patients for Hospice Discharge","authors":"Benjamin Hammond ,&nbsp;Danielle Olson ,&nbsp;Abhishek Ganta ,&nbsp;Kenneth Egol ,&nbsp;Sanjit Konda","doi":"10.1016/j.jcot.2025.103225","DOIUrl":"10.1016/j.jcot.2025.103225","url":null,"abstract":"<div><h3>Background</h3><div>Hip fracture patients may be hospice candidates if life expectancy is &lt; 6 months. This study evaluates STTGMAHIP FX's ability to identify high-risk hip fracture patients for hospice discharge at emergency room presentation to guide end-of-life care planning.</div></div><div><h3>Methods</h3><div>A retrospective analysis of a prospectively maintained registry of patients aged ≥55 with low-energy hip fractures (2014–2024) was conducted. Patients were stratified by STTGMAHIP FX percentiles: minimal (≤50th), low (50th–&lt;80th), moderate (80th–&lt;97.5th), and high (≥97.5th). Demographics, injury characteristics, treatment, and outcomes were recorded. The primary outcome was identification of Hospice Discharge Candidates (HDCs), defined as discharge to hospice during the index admission, inpatient mortality &gt;48 h after surgery, or mortality &lt;6 months post-operation. American Society of Anesthesiologists (ASA) score was compared to STTGMAHIP FX for the ability to cluster HDCs using area under receiver operating characteristic (AUROC) curve analysis and a two-proportion Z-test.</div></div><div><h3>Results</h3><div>Among 2777 patients (mean age 81.18 ± 9.80 years), HDC incidence rose with STTGMAHIP FX risk level: 2.9% (minimal risk), 5.9% (low risk), 14.2% (moderate risk), and 29.6% (high risk) (p &lt; 0.05). Only 17.0% of patients classified as ASA 4 were HDCs. Additionally, STTGMAHIP FX demonstrated a slightly better ability to discriminate HDCs compared to ASA, although not statistically significant (0.719 vs 0.683; p = 0.138). However, the STTGMAHIP FX high risk stratification was much more useful in identifying HDCs than ASA (29.6% vs 17.0%; p = 0.013).</div></div><div><h3>Conclusion</h3><div>STTGMAHIP FX identifies hospice-eligible hip fracture patients more effectively than ASA. High-risk patients per STTGMAHIP FX demonstrate elevated 6-month mortality and may benefit from early hospice planning at admission.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103225"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145223580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“The silent strain: Exploring self-image and mental health in braced adolescents with scoliosis”: a scoping review","authors":"Sari Wathiq Al Hajaj ,&nbsp;Dawod Al Hajaj ,&nbsp;Prabhjit Singh ,&nbsp;Sanjeevi Bharadwaj ,&nbsp;VishnuV. Nair ,&nbsp;Sriram harish srinivasan","doi":"10.1016/j.jcot.2025.103217","DOIUrl":"10.1016/j.jcot.2025.103217","url":null,"abstract":"<div><h3>Background</h3><div>Adolescent Idiopathic Scoliosis (AIS) is a common spinal deformity. It can create surface deformities that affect adolescents' psychosocial health. Bracing is a non-surgical method to prevent curve progression and avoid surgery. However, the psychosocial effects of long-term brace use during adolescence are often overlooked. issues like decreased self-esteem, social withdrawal, and appearance anxiety may hinder compliance and impact quality of life.</div></div><div><h3>Methods</h3><div>A comprehensive literature review used PubMed, Cochrane Library, and ScienceDirect to identify studies from 2015 to 2025. It was prospectively registered with the PROSPERO database (Registration ID: CRD420251083129). The search terms included: \"adolescent idiopathic scoliosis,” \"bracing and self-image,” \"bracing compliance,” and \"psychological impact of bracing.” Two independent reviewers screened studies based on PICOS criteria: (1) adolescents with AIS, (2) bracing or conservative treatment, (3) control or observational groups, (4) outcomes like self-image, quality of life, or compliance, and (5) RCTs, observational studies, systematic reviews, or meta-analyses. Exclusions included surgical interventions, non-adolescents, or non-English publications.</div></div><div><h3>Results</h3><div>We found 807 studies; after removing duplicates, irrelevant titles, and abstracts, 26 full texts were screened. Of these, 10 met all criteria and were included. Adolescents in brace treatment often face negative self-image, low self-esteem, and social anxiety, especially at therapy start, affecting adherence. Concerns about appearance and discomfort hinder compliance. Some adapt over time, but others continue to experience mental health issues. Interventions like cognitive-behavioural therapy (CBT), peer support, and special exercise programs improve coping, adherence, and psychological well-being.</div></div><div><h3>Conclusion</h3><div>Bracing treats Adolescent Idiopathic Scoliosis (AIS) but affects psychosocial well-being, lowering adherence and quality of life. A multidisciplinary, patient-centred approach with mental health support is essential. Early psychological distress identification and interventions like Cognitive Behavioural Therapy (CBT) and peer support can enhance compliance and outcomes. Protocols should include psychosocial screening and holistic care to lessen the adverse effects of brace treatment.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"70 ","pages":"Article 103217"},"PeriodicalIF":0.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of surgeon-point-of-view recording in undergraduate surgical pedagogy: A Systematic Review","authors":"Deepankar Satapathy,&nbsp;Ranjith Kumar Yalamanchali,&nbsp;Deepak Kumar Maley,&nbsp;Maheshwar Lakkireddy,&nbsp;Syed Ifthekar","doi":"10.1016/j.jcot.2025.103219","DOIUrl":"10.1016/j.jcot.2025.103219","url":null,"abstract":"<div><h3>Background</h3><div>The Indian medical curriculum recently included Early Clinical Exposure (ECE) to enhance the undergraduate medical training. A key challenge in in implementing it in surgical education is to ensure adequate operating room (OR) exposure, while maintaining sterility and minimizing the OR traffic. Traditional teaching methods such as surgical simulators and virtual dissecting tables provide anatomical insights but lack the immersive experience of an actual OR setting. Intraoperative video recordings, particularly using compact and surgeon-controlled devices like GoPro cameras, offer an effective alternative for augmenting the surgical training. This study intends to assess the scope of recording technologies in enhancing undergraduate medical education in the surgical subjects.</div></div><div><h3>Methodology</h3><div>This study was registered in PROSPERO database and the registration number is CRD420251049770.A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</div><div>A comprehensive search of PubMed, Embase, and Google Scholar was performed using MeSH and non-MeSH terms related to surgical recording technologies. Articles describing the use of head-mounted or point-of-view cameras like GoPro or Google Glass, for live teaching and surgical training were included, while those using instrument-mounted cameras (e.g., arthroscope, endoscope) or hypothetical discussions were excluded. Data extraction focused on the type and number of cameras used, their purpose, and the target audience.</div></div><div><h3>Results</h3><div>A total of 1472 articles on surgical video recording were identified. Following the elimination of duplicates, 964 records were evaluated, resulting in the exclusion of 818 based on title and abstract analysis. Following full-text evaluation of 146 articles, 25 studies met the inclusion criteria. The majority of studies were conducted in general surgery and orthopaedics (n = 7), followed by neurosurgery (n = 4). Overhead camera systems were used in 21 studies, while tripod-mounted cameras were used in three studies. Most studies employed GoPro Hero 4, 5, and 6 models. The studies primarily focused on undergraduate teaching (n = 19), with some evaluating postgraduate training (n = 3).</div></div><div><h3>Conclusion</h3><div>Head-mounted recording devices, such as GoPro cameras, provide an effective, cost-efficient, and easily implementable tool for surgical instruction. They enhance undergraduate training by offering a OR exposure perspective while maintaining sterility and reducing OR congestion. The integration of sports camera-based intra operative recording should be considered a standard component of practical instruction in medical schools to improve surgical education and training outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"70 ","pages":"Article 103219"},"PeriodicalIF":0.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncertainty quantification and explainable AI in orthopaedic imaging: A timely call to action","authors":"Ahmad P. Tafti ,&nbsp;Qiangqiang Gu ,&nbsp;Johannes F. Plate","doi":"10.1016/j.jcot.2025.103208","DOIUrl":"10.1016/j.jcot.2025.103208","url":null,"abstract":"<div><div>Artificial intelligence (AI) has made a big leap in orthopaedic imaging, with deep learning models achieving remarkable accuracy in tasks such as knee osteoarthritis classification and grading, fracture detection, and implant assessment. Yet accuracy in AI models alone is insufficient for clinical trust, adoption, and uptake. Orthopaedic decision-making often carries high risk settings, where any misclassification or overconfidence can have significant consequences for treatment recommendations and patient outcomes. Despite this reality, most current AI models operate as “close boxes”, providing predictions without clarifying their reasoning or quantifying uncertainty. This forum article argues that the integration of uncertainty quantification and explainable AI is no longer optional, but a timely call to action for the orthopaedic community. Uncertainty quantification methods can highlight when predictions are unreliable, prompting confirmatory testing or human oversight, while explainable AI techniques provide transparency into model reasoning, enabling surgeons and radiologists to better interpret AI outputs. Together, these advances are essential components of trustworthy AI, bridging the gap between technical innovation and real-world orthopaedic practice. By embracing uncertainty-aware and explainable AI models, orthopaedic imaging can move beyond accuracy toward accountability, responsibility, and safer integration into clinical workflows. The time to act is now.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"70 ","pages":"Article 103208"},"PeriodicalIF":0.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Tuning into Learning’: A scoping review of podcasts and webinars in orthopaedic education\"","authors":"Jessica Elilnesan ,&nbsp;Karthic Swaminathan ,&nbsp;Vishaal Vinodh Kumar ,&nbsp;Vishnu Priyan Rajan ,&nbsp;Alexander Curran ,&nbsp;Faizal Rayan","doi":"10.1016/j.jcot.2025.103216","DOIUrl":"10.1016/j.jcot.2025.103216","url":null,"abstract":"<div><h3>Background</h3><div>Podcasts and webinars have been increasingly used in medical education, particularly as a lifeline during the pandemic to ensure continued education. The aim of this study is to review literature exploring the use of podcasts and webinars as educational tools in orthopaedics by consolidating evidence of their benefits, challenges, and potential for future integration into orthopaedic training.</div></div><div><h3>Methods</h3><div>A literature search was performed across: PubMed, Cochrane Library, EBSCOhost, CINAHL and Scopus using selected MeSH terms and search terms related to podcasts, webinars and orthopaedic education across the years 2015–2025. Studies were reviewed by two independent authors using predefined inclusion/exclusion criteria. Key findings were collated in a database.</div></div><div><h3>Results</h3><div>A total of 22 articles were selected for review, with 11 studies referencing podcasts and 11 on the use of webinars. Studies generally reported a positive impact of these methods in orthopaedic education with highly rated reviews from trainees based on Likert scales, numerical rating scales and qualitative feedback.</div></div><div><h3>Conclusion</h3><div>Podcasts and webinars are a valuable tool in orthopaedics and their use has addressed issues with traditional learning approaches. For continued growth, further effort is required for quality control and improving accessibility to maximise educational potential in orthopaedic training.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"70 ","pages":"Article 103216"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of structured orthopaedic education on musculoskeletal knowledge among non-orthopaedic healthcare professionals: A narrative review","authors":"Aakash Choudhary ,&nbsp;Sammarjanki Rymbai ,&nbsp;Suresh K. Sharma ,&nbsp;Nitesh Gahlot","doi":"10.1016/j.jcot.2025.103215","DOIUrl":"10.1016/j.jcot.2025.103215","url":null,"abstract":"<div><h3>Background</h3><div>Over 1.7 billion people worldwide suffer from musculoskeletal disorders (MSDs), which include osteoarthritis, osteoporosis, and low back pain. These ailments account for 149 million years of life with a handicap. General practitioners, nurses, and emergency physicians are examples of non-orthopaedic healthcare workers who frequently lack formal training in musculoskeletal assessment and management, despite their significant frequency. This disparity in education leads to subpar patient treatment, improper referrals, and delayed diagnosis, especially in low- and middle-income countries (LMICs).</div></div><div><h3>Methodology</h3><div>This narrative review assesses the extent and constraints of orthopaedic education for non-orthopaedic healthcare practitioners by looking at current medical and nursing curricula in India, global health data, and existing research and literature searches in PubMed, EMBASE and web of science. The search included studies on orthopaedic education in curricula, english language, peer reviewed studies from 2004 to 2024. It highlights difficulties such limited clinical exposure, a lack of standardised training, time restrictions, and a lack of resources. Triage procedures, early education initiatives, and collaborative care models' effects on enhancing the provision of musculoskeletal healthcare are also covered in the review.</div></div><div><h3>Results</h3><div>Research indicates that non-specialist healthcare practitioners have a serious lack of orthopaedic understanding. Musculoskeletal health receives less attention in medical and nursing undergraduate and graduate programs in India. According to studies, improved triage and musculoskeletal care training enhances early red flag detection, maximises resource allocation, and lowers long-term consequences. Advanced-trained physical therapists routinely perform better on MSD assessments than many other medical professionals. Effective methods to narrow this gap include national curriculum standardisation and collaborative, case-based learning.</div></div><div><h3>Conclusion</h3><div>Current deficiencies include inadequate curricular emphasis, restricted clinical exposure, lack of standardized training, resource constraints, and time pressures. Strategies to overcome these deficiencies include integrating standardized modules such as GALS and pGALS, case-based and simulation-based learning, developing e-learning repositories and promoting interprofessional collaborations. Also triage training and early education initiatives can further strengthen skills of the healthcare professionals and a stratified training framework can ensure competency development, ultimately improving musculoskeletal care and patient outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"70 ","pages":"Article 103215"},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of deep learning models for early detection of osteoarthritis using knee radiographs: A retrospective study","authors":"Ajay Sharma ,&nbsp;Jujhar Singh ,&nbsp;Appan Kumar ,&nbsp;Vedant Bajaj ,&nbsp;Shubham Gupta","doi":"10.1016/j.jcot.2025.103212","DOIUrl":"10.1016/j.jcot.2025.103212","url":null,"abstract":"<div><h3>Background</h3><div>Knee osteoarthritis is a prevalent degenerative joint disease leading to pain and disability worldwide. Early detection is critical to initiating treatment strategies that can delay disease progression. While deep learning models have shown promise in automating Osteoarthritis detection from radiographs, comparative studies assessing their efficacy for early-stage detection remain limited. The aim of this study was to evaluate and compare the performance of three deep learning architectures for early detection of knee osteoarthritis using radiographic imaging.</div></div><div><h3>Materials and methods</h3><div>A retrospective study analysing 1200 knee radiographs (1000 training, 200 validation) collected from 2022 to 2024. Three deep learning models (custom CNN, ResNet-50, and VGG-16) were implemented and trained using PyTorch. Performance was evaluated using accuracy, sensitivity, specificity, and AUC-ROC metrics. Ground truth was established through independent assessment by three experienced orthopaedic surgeons using the Kellgren-Lawrence grading system.</div></div><div><h3>Results</h3><div>ResNet-50 demonstrated superior performance with accuracy 0.912 ± 0.018, sensitivity 0.908 ± 0.021, specificity 0.916 ± 0.017, and AUC 0.934 ± 0.013. VGG-16 followed with accuracy 0.887 ± 0.020, while the custom CNN achieved 0.853 ± 0.025. Statistical analysis confirmed significant differences between models (p &lt; 0.01). Inter-observer agreement (kappa = 0.83 ± 0.02) indicated strong concordance between AI predictions and expert assessments. Model performance remained consistent across demographic subgroups, with only minimal variations based on age and BMI.</div></div><div><h3>Conclusion</h3><div>ResNet-50 architecture demonstrated optimal performance for early osteoarthritis detection, combining high accuracy with clinically viable processing speeds. The model's consistency across demographic subgroups and strong inter-observer agreement suggests potential for reliable clinical implementation in automated screening workflows.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"70 ","pages":"Article 103212"},"PeriodicalIF":0.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical evaluation of interlaminar endoscopic discectomy in lumbar disc herniation by Destandau's technique","authors":"Amarkant Thakur,&nbsp;Vedpal Yadav,&nbsp;Pankaj Kumar","doi":"10.1016/j.jcot.2025.103210","DOIUrl":"10.1016/j.jcot.2025.103210","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the clinical outcomes of interlaminar endoscopic discectomy using Destandau's technique in patients with symptomatic lumbar disc herniation, focusing on functional improvement, pain relief, and overall patient satisfaction.</div></div><div><h3>Materials and methods</h3><div>This prospective observational study was conducted in the Department of Orthopaedic Surgery at a tertiary care hospital. Surgical intervention in all cases was performed using Destandau's technique for interlaminar endoscopic lumbar discectomy, a minimally invasive procedure involving an endospine system to access and decompress the affected nerve root.</div><div>A total of 15 patients aged between 18 and 60 years with symptomatic lumbar disc herniation refractory to at least six weeks of conservative treatment were included. Preoperative assessment comprised clinical and neurological evaluation and standardised outcome measures, including the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for pain, and the Macnab Outcome Score.</div><div>Postoperative care included appropriate analgesia, early mobilisation, and scheduled follow-up visits at 2 weeks, 6 weeks, and 3 months to monitor recovery and assess outcomes.</div></div><div><h3>Results</h3><div>The mean age of participants was 36.47 ± 8.33 years, with a male predominance (66.7 %). L5-S1 was the most commonly affected level (53.3 %). ODI and VAS scores showed significant improvement at 2 weeks, 6 weeks, and 3 months (p &lt; 0.001). According to McNab's criteria, 26.7 % achieved excellent outcomes, 53.3 % good, and 20 % fair. Complication rates were minimal, and hospital stays were brief, with 86.7 % discharged within 2 days.</div></div><div><h3>Conclusion</h3><div>Endoscopic discectomy using the Destandau technique significantly reduced pain and disability scores, along with favourable functional outcomes over a 3-month follow-up period. These findings support its effectiveness in the surgical management of symptomatic lumbar disc herniation.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"70 ","pages":"Article 103210"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors associated with nosocomial infections in pelvic ring and acetabular fractures: A case-control study","authors":"Edgar Manuel Bodu-Lamberti ,&nbsp;Juanita Fetecua-Chaparro ,&nbsp;Juan Olivella Gómez ,&nbsp;Camila Karduss-Preciado ,&nbsp;Nicoll Navarro Gutierrez ,&nbsp;Juan Guillermo Ortiz-Martinez","doi":"10.1016/j.jcot.2025.103211","DOIUrl":"10.1016/j.jcot.2025.103211","url":null,"abstract":"<div><h3>Background</h3><div>To identify potential risk factors associated with the development of nosocomial infections in patients with pelvic ring and acetabular fractures.</div></div><div><h3>Methods</h3><div>A case-control study was conducted at a tertiary trauma centre in Colombia, from January 2019 to May 2024. Patients with ICD-10 codes corresponding to pelvic ring and acetabular fractures were selected. After the application of inclusion and exclusion criteria, a final sample of 103 eligible participants was obtained. Qualitative and quantitative variables were analysed by standard methods. Odds ratios with 95 % confidence intervals were calculated using cross-tabulations. Statistical significance was determined using a two-tailed <em>t</em>-test with a threshold of 0.05 and ROC analyses were implemented.</div></div><div><h3>Results</h3><div>Mean age of the study population was 45.3 ± 20.61 years, consisting mostly of males (n = 68, 66.01 %) and road traffic accidents (n = 53, 51.45 %). The overall rate of infection was 22.3 % (n = 23), led by tracheitis (n = 9, 8.73 %), catheter associated UTI (n = 8, 7.76 %) and surgical site infection (n = 7, 6.79 %). Among independent predictors, the best performing variables were hospital LOS, ISS, creatinine, and ICU LOS (AUCs 0.88-0.78). Two deaths (1.94 %) were recorded in the infected subgroup at 10 and 34 days after admission.</div></div><div><h3>Conclusion</h3><div>Pelvic ring and acetabular fractures are linked to high rates of infectious complications, due to high-energy trauma, prolonged hospital stays and acute kidney failure. Recognizing these associations can inform early clinical decision-making and resource allocation, ultimately improving patient outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"70 ","pages":"Article 103211"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facet joint loading after Kevlar-reinforced disc replacement vs. lumbar fusion. A cadaveric model study","authors":"Amparo Vanaclocha ,&nbsp;Vicente Vanaclocha ,&nbsp;Carlos Atienza ,&nbsp;Pablo Jorda-Gomez ,&nbsp;Andres Peñuelas ,&nbsp;David Gomez-Lopez","doi":"10.1016/j.jcot.2025.103204","DOIUrl":"10.1016/j.jcot.2025.103204","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar spinal fusion, while effective for degenerative disc disease, eliminates motion and may accelerate adjacent segment degeneration. Total disc replacement (TDR) with anterior annular reinforcement may offer a motion-preserving alternative.</div></div><div><h3>Objective</h3><div>To compare spinal kinematics and facet joint pressures between (1) total lumbar disc replacement with anterior Kevlar band reinforcement (TDR group) and (2) standard 360° lumbar fusion (fusion group) in a cadaveric model.</div></div><div><h3>Methods</h3><div>Six fresh-frozen human lumbar spines (L2–S1) were tested in a custom motion simulator under both surgical conditions at L4–L5. Kinematic parameters included range of motion (ROM), peak angles, and motion harmony (angle–acceleration correlation). Zygapophyseal joint pressures were measured using Tekscan sensors. Data were analyzed using repeated-measures ANOVA.</div></div><div><h3>Results</h3><div>The TDR group preserved significantly greater flexion (−25.7° vs −21.8°, <em>p</em> &lt; 0.001) and left axial rotation (<em>p</em> = 0.025), while the fusion group showed greater extension (<em>p</em> &lt; 0.001). TDR demonstrated superior motion harmony across all axes (<em>p</em> &lt; 0.01) and better preserved ROM at adjacent levels. No significant differences in mean maximum facet joint pressures were observed (<em>p</em> &gt; 0.05), though slightly higher values were noted in TDR during axial rotation.</div></div><div><h3>Conclusion</h3><div>Anterior annular reconstruction with Kevlar bands during total disc replacement restores near-physiological motion and improves kinematic control without increasing facet joint stress. This technique may offer a biomechanically favorable alternative to lumbar fusion.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"70 ","pages":"Article 103204"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}