Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Association of albumin, ASA class, and time with mortality, Re-admission, and Re-operation after proximal femoral fracture fixation","authors":"Niam Patel ,&nbsp;Thor S. Stead ,&nbsp;Eric Yang ,&nbsp;Latha Ganti","doi":"10.1016/j.jcot.2025.103334","DOIUrl":"10.1016/j.jcot.2025.103334","url":null,"abstract":"<div><h3>Background</h3><div>Femoral fractures are common, high-energy injuries associated with substantial morbidity. Although surgical fixation remains the mainstay of treatment, outcomes vary widely, and predictors of adverse events are not fully defined. This study aimed to identify clinical and perioperative factors associated with 30-day mortality, readmission, and re-operation after femoral fracture fixation.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort analysis of adult patients undergoing femoral fracture fixation between 2018 and 2022 using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Outcomes included 30-day mortality, unplanned readmission, and re-operation. Predictors assessed included demographic, clinical, and perioperative variables such as age, ASA class, albumin, operative time, comorbidities, and laboratory values. Univariate associations were examined, followed by multivariate logistic regression to identify independent predictors. Odds ratios with 95 % confidence intervals and receiver operating characteristic (ROC) curves were reported.</div></div><div><h3>Results</h3><div>Among 63,734 patients, 9499 experienced an adverse event. Thirty-day mortality occurred in 3543 patients (5.6 %), most strongly associated with advanced age, higher ASA class, lower preoperative albumin, cancer, COPD, CHF, renal failure, and male sex. Readmission (n = 4776) was predicted by low albumin, ASA class, COPD, cancer, CHF, diabetes, steroid use, and general anesthesia. Re-operation (n = 1180) was primarily associated with hypoalbuminemia and prolonged operative time. Multivariate modeling demonstrated that preoperative albumin, ASA class, and operative duration were the most consistent predictors across outcomes. Model performance was strongest for mortality (AUC 0.77) and more modest for readmission and re-operation (AUC ∼0.61).</div></div><div><h3>Conclusion</h3><div>This large, national study highlights preoperative albumin, ASA class, and operative duration as central markers of postoperative mortality, readmission, and re-operation after femoral fracture fixation. These findings underscore the importance of optimizing nutritional status, recognizing physiologic reserve, and streamlining perioperative processes to mitigate risk and improve outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103334"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078150","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 applications of artificial intelligence in hand surgery: A systematic review and meta-analysis","authors":"J. Terrence Jose Jerome ,&nbsp;Vivaan Jain","doi":"10.1016/j.jcot.2026.103335","DOIUrl":"10.1016/j.jcot.2026.103335","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is increasingly applied in medicine, yet its clinical integration in hand surgery remains variable and incompletely validated. This systematic review and meta-analysis evaluated current AI applications in hand surgery and benchmarked performance against human comparators where available.</div></div><div><h3>Methods</h3><div>Following PRISMA 2020 guidelines, PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library were searched through October 2025. Eligible studies evaluated AI systems in hand or wrist surgery with reported performance metrics. Outcomes included diagnostic accuracy, prognostic discrimination, concordance with clinical recommendations, workflow impact, and user satisfaction. Meta-analysis using a bivariate random-effects model was performed when ≥3 comparable studies were available and was restricted to radiograph-based fracture detection (distal radius and scaphoid). All other applications were synthesized narratively due to heterogeneity. The protocol was registered with PROSPERO (CRD420251230505).</div></div><div><h3>Results</h3><div>Of 1228 screened records, 98 studies met inclusion criteria, most addressing diagnostic imaging. For distal radius fractures, pooled AI sensitivity and specificity were 92 % and 89 %, compared with 95 % and 94 % for human readers. For scaphoid fractures, AI demonstrated higher sensitivity (85 % vs. 71 %) but lower specificity (83 % vs. 93 %). Prognostic machine-learning models outperformed clinician estimates in selected retrospective cohorts (mean accuracy 78 % vs. 65 %), although calibration and external validation were inconsistently reported. Large language models demonstrated feasibility in simulated settings, achieving passing specialty-exam scores and generating high-quality documentation (mean satisfaction 4.6/5), while showing high sensitivity but variable specificity in treatment recommendations. Robotic and instrument-tracking applications remain experimental.</div></div><div><h3>Conclusions</h3><div>AI demonstrates promise in selected hand-surgery tasks, particularly fracture detection, outcome prediction, and documentation support. However, evidence is predominantly retrospective and single-center. Prospective multicenter validation and careful attention to bias, transparency, and ethical safeguards are required before routine clinical adoption. AI should augment—not replace—clinical expertise.</div></div><div><h3>Level of evidence</h3><div>II (systematic review/meta-analysis of predominantly Level II–III studies).</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103335"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928358","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":"Erratum regarding missing statements in previously published articles","authors":"","doi":"10.1016/j.jcot.2026.103339","DOIUrl":"10.1016/j.jcot.2026.103339","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103339"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188524","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":"Erratum to \"Hip arthrogram in developmental dysplasia of the hip: A review\" [J Clin Orthop Trauma 69 (2025) 103134]","authors":"Deepika Pinto ,&nbsp;Daniel Phillip Thomas ,&nbsp;Clare Carpenter","doi":"10.1016/j.jcot.2025.103321","DOIUrl":"10.1016/j.jcot.2025.103321","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103321"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188526","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":"Erratum regarding missing statements in previously published articles","authors":"","doi":"10.1016/j.jcot.2026.103341","DOIUrl":"10.1016/j.jcot.2026.103341","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103341"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189169","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":"A prospective randomized comparative study of surgeon administered adductor canal block with epidural analgesia in primary TKA","authors":"Gaurav Gupta ,&nbsp;Akshay Ramesh Gupta ,&nbsp;Vinit Kumar Singh","doi":"10.1016/j.jcot.2025.103320","DOIUrl":"10.1016/j.jcot.2025.103320","url":null,"abstract":"<div><h3>Background</h3><div>Total knee replacement stands as a reliable solution for patients experiencing severe knee osteoarthritis, yet persistent discomfort following the procedure can significantly impede the return to mobility and rehabilitation efforts. While epidural techniques have long supported pain control after surgery, they can cause issues like limited movement ability and urinary challenges. This investigation compared intraoperative surgeon-delivered adductor canal blockade with epidural analgesia in patients undergoing primary unilateral total knee replacement, focusing on early analgesia and rehabilitation.</div></div><div><h3>Methods</h3><div>A prospective analysis was performed in a tertiary orthopaedic hospital in northern India, involving 50 individuals undergoing lower limb joint replacement. Patients were divided equally into 2 groups one receiving adductor canal (25) or epidural (25) pain management approaches. All procedures were carried out under regional spinal anaesthetia. Postoperative discomfort was gauged using a Visual Analog Scale (VAS) at set intervals after surgery, and functional outcomes were captured with standardized knee scoring systems and joint movement measurements. Statistics were interpreted using appropriate tests, with significance assumed for values below 0.05.</div></div><div><h3>Results</h3><div>ACB patients reported significantly lower pain scores on postoperative days 0-1 compared to CEA patients (p = 0.0001). Measures of knee function and mobility at day three favoured the adductor canal approach, and a greater proportion of these patients achieved robust knee flexion early in their recovery. Additionally, hospital discharge was expedited, and the return of quadriceps strength was more prevalent among those managed with the adductor canal block.</div></div><div><h3>Conclusion</h3><div>In this small, pragmatic prospective randomized comparative study, surgeon-delivered adductor canal block was associated with lower early postoperative pain scores, reduced opioid consumption, faster functional recovery, and shorter hospital stay compared with continuous epidural analgesia within the first 72 h after total knee arthroplasty.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103320"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928360","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":"Venous thromboembolism prophylaxis in obstetric patients after orthopedic injury: a systematic review","authors":"Linnea Fischer ,&nbsp;Erika Ratcliff ,&nbsp;David N. Hackney ,&nbsp;Emily Hamburg-Shields","doi":"10.1016/j.jcot.2026.103346","DOIUrl":"10.1016/j.jcot.2026.103346","url":null,"abstract":"<div><h3>Background</h3><div>To determine the risk of venous thromboembolism (VTE) and the clinical practice pattern for VTE prophylaxis after orthopedic fracture in pregnant and postpartum patients. This review was registered in PROSPERO (ID CRD42024499753).</div></div><div><h3>Methods</h3><div>Literature searches of PubMed, Embase, Web of Science, and <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> were performed using key words relating to orthopedic fracture in pregnancy and VTE prophylaxis. Of 640 studies screened, 17 articles were eligible for inclusion. The primary outcome was whether VTE prophylaxis was administered and the medication, dose, and duration. Secondary outcomes included clinical characteristics of the pregnancy and fracture and the occurrence of complications including VTE. Data were analyzed by descriptive statistics and narrative synthesis, as the lack of controlled studies precluded meta-analysis.</div></div><div><h3>Results</h3><div>The 17 eligible studies were all case reports or small case series. 26 cases were reported in which a fracture occurred during the prenatal period. Of the 26 patients, 23 received pharmacologic VTE prophylaxis. The majority received low molecular weight heparin (LMWH) or unfractionated heparin (UFH). Duration of prophylaxis ranged from 6 days to 20 weeks (the remainder of the pregnancy). Only one patient in the eligible reports had a VTE event; this patient had not received VTE prophylaxis. No complications of VTE prophylaxis were reported.</div></div><div><h3>Conclusion</h3><div>Pharmacologic VTE prophylaxis is typically recommended in the general population after major orthopedic surgery and major traumatic injuries. Pregnant patients may be at additionally elevated risk of VTE after orthopedic injury compared to non-pregnant patients. The degree of benefit of VTE prophylaxis and the appropriate duration of therapy is not known due to lack of controlled studies in this population.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103346"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978608","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":"Management of civilian gunshot limb injuries: A comparison of Early Total Care and Damage Control Orthopedics","authors":"Ammar Ghabi ,&nbsp;Thibault Druel ,&nbsp;Jean-Baptiste Odent ,&nbsp;Hugues Pascal-Moussellard ,&nbsp;Bernard de Geofroy ,&nbsp;Laurent Mathieu","doi":"10.1016/j.jcot.2026.103344","DOIUrl":"10.1016/j.jcot.2026.103344","url":null,"abstract":"<div><h3>Background</h3><div>Gunshot-related limb injuries are increasingly seen in civilian settings. Surgical management may follow either Damage Control Orthopaedics (DCO) or Early Total Care (ETC) principles.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 222 civilian patients with gunshot-related limb injuries treated between 2012 and 2023 across five French trauma centers. Patients were grouped according to initial surgical strategy: DCO or ETC. The primary outcome was bone healing; secondary outcomes included infection rates and reoperations.</div></div><div><h3>Results</h3><div>ETC patients showed significantly higher union rates (88 % vs. 76 %) and lower infection and reoperation rates. However, the DCO group presented significantly higher Injury Severity Scores and more frequent vascular and nerve injuries, reflecting greater injury severity.</div></div><div><h3>Conclusion</h3><div>ETC may be associated with improved outcomes in selected civilian patients with gunshot limb injuries. However, significant selection bias limits the interpretation of comparative results. Further prospective studies are needed to validate these findings.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103344"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038343","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":"Early onset scoliosis in syndromic and neuromuscular disorders: A multidisciplinary approach","authors":"Aaron J. Wey,&nbsp;Alexander J. Schüpper,&nbsp;Travis S. CreveCoeur,&nbsp;Amer F. Samdani","doi":"10.1016/j.jcot.2026.103345","DOIUrl":"10.1016/j.jcot.2026.103345","url":null,"abstract":"<div><div>Children with neuromuscular and syndromic disorders are among the most medically fragile patients in pediatric spine care. Conditions such as cerebral palsy, myelomeningocele, spinal muscular atrophy, neurofibromatosis type 1, Marfan syndrome, and Prader–Willi syndrome carry a high risk of early-onset scoliosis during critical periods of thoracic and pulmonary development. In these populations, scoliosis is rarely an isolated problem; it reflects the cumulative burden of neurologic impairment, connective tissue fragility, cardiopulmonary compromise, nutritional deficiency, and systemic disease. This review highlights the clinical and surgical challenges unique to each condition while emphasizing the central role of multidisciplinary care. In cerebral palsy, scoliosis risk correlates with motor severity and is compounded by respiratory and nutritional compromise. In myelomeningocele, neurosurgical and urologic coordination is essential given the prevalence of shunt dependence, Chiari malformation, tethered cord, and neurogenic bladder. In spinal muscular atrophy, perioperative pathways center on airway clearance, noninvasive ventilation, and nutritional optimization. Neurofibromatosis type 1 is distinguished by dystrophic scoliosis and dural ectasia, requiring advanced imaging and tailored instrumentation, while families often seek broader clinic support from genetics, oncology, and ophthalmology. In Marfan syndrome, connective tissue fragility complicates fixation, and combined management with cardiology and chest wall specialists is often required. For Prader–Willi syndrome, obesity, endocrine dysfunction, and severe sleep apnea demand careful optimization. Evidence demonstrates that standardized multidisciplinary pathways shorten hospitalizations, reduce pulmonary and infectious complications, and improve consistency of care. Beyond measurable outcomes, families report greater trust and satisfaction when diverse specialties are integrated. Together, these findings reinforce that optimal management of neuromuscular and syndromic scoliosis depends not only on surgical expertise, but also on coordinated, comprehensive, and lifelong care.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103345"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078149","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":"Controversies in management of floating lateral mass fractures of subaxial cervical spine: a narrative review","authors":"Ratko Yurac ,&nbsp;Andrei Joaquim ,&nbsp;Sebastian Bigdon ,&nbsp;Mohamed M. Aly ,&nbsp;Ignacio Cirillo ,&nbsp;Gaurav Dhakal ,&nbsp;Klaus Schnake ,&nbsp;Richard Bransford ,&nbsp;Gregory Schroeder ,&nbsp;Mohammad El-Sharkawi ,&nbsp;Philipp Schleicher ,&nbsp;AO Spine Knowledge Forum Trauma & Infection","doi":"10.1016/j.jcot.2026.103349","DOIUrl":"10.1016/j.jcot.2026.103349","url":null,"abstract":"<div><div>This narrative review examines floating lateral mass (F3) fractures of the subaxial cervical spine, uncommon but clinically relevant injuries that are frequently under-recognized. A comprehensive literature search was conducted in PubMed, Embase, LILACS, and the Cochrane Library to identify studies published between 1990 and May 2025. These fractures result from combined pedicle and lamina disruption, separating the articular processes and creating a “floating” lateral mass. Despite advances in imaging, assessment of mechanical instability remains controversial, particularly in minimally displaced injuries.</div><div>Magnetic resonance imaging is essential for identifying associated intervertebral disc and posterior ligamentous complex injuries, which are strongly associated with failure of non-operative treatment. Surgical management is commonly indicated when instability or neurological compromise is present, with anterior cervical discectomy and fusion being the most frequently reported approach. However, the optimal strategy, including anterior, posterior, or combined fixation and the number of stabilized levels, remains debated and is guided by fracture morphology, reducibility, and disco-ligamentous involvement. Dynamic radiographs and computed tomography angiography may provide complementary information in selected cases.</div><div>Overall, these fractures should be considered potentially unstable. Surgical stabilization is appropriate in most patients, whereas conservative management may succeed in carefully selected stable cases with close clinical and radiographic follow-up.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103349"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078151","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}