Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Determining the change in functional outcome score and CT fusion ratio following arthroscopic subtalar arthrodesis: A prospective observational study","authors":"Bishwa Bandhu Niraula ,&nbsp;Anil Regmi ,&nbsp;Shivam Bansal ,&nbsp;Saptarshi Barman ,&nbsp;Rohan Gowda ,&nbsp;Pradeep Kumar Meena","doi":"10.1016/j.jcot.2025.103280","DOIUrl":"10.1016/j.jcot.2025.103280","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the change in foot and ankle functional outcome scores and the CT fusion ratio after Posterior Arthroscopic Subtalar Arthrodesis (PASTA) in patients with isolated subtalar arthritis.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted from March 2021 to March 2023, enrolling 20 patients (12 males, 8 females) with posttraumatic or degenerative isolated subtalar arthritis. Functional outcomes were assessed at 6 weeks, 3 months, and 6 months postoperatively using AOFAS, FADI, FAOS, and VAS scores. Fusion was assessed via CT scan at 6 months to calculate the CT fusion ratio.</div></div><div><h3>Results</h3><div>Functional outcomes significantly improved over time. The mean AOFAS score increased from 48.0 ± 8.53 preoperatively to 83.8 ± 9.73 at 6 months. The mean FADI and FAOS scores improved from 42.85 ± 7.11 and 43.35 ± 8.78 preoperatively to 86.5 ± 11.38 and 86.75 ± 11.15, respectively, at 6 months. The VAS score decreased from a mean of 4.9 ± 0.89 at 6 weeks to 1.6 at 6 months. The mean CT fusion ratio at 6 months was 65.39 % ± 13.98 %. Only one patient showed a fusion ratio below 33 % and later required ankle arthrodesis. A significant positive correlation was observed between CT fusion ratio and AOFAS (ρ = 0.64, p = 0.002), FADI (ρ = 0.55, p = 0.010), and FAOS (ρ = 0.45, p = 0.043). Most patients rated satisfaction as “excellent” at final follow-up. Minor complications such as transient pain and swelling were observed but resolved over time.</div></div><div><h3>Conclusion</h3><div>Arthroscopic subtalar arthrodesis significantly improved functional outcomes and demonstrated a high CT fusion rate with minimal complications in patients with isolated subtalar arthritis.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103280"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839740","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":"Weekend surgery is associated with increased use of hemiarthroplasty for displaced femoral neck fractures: A propensity-matched study","authors":"Stephen C. Moye ,&nbsp;Austin T. Gregg ,&nbsp;Thirushan Wignakumar ,&nbsp;Adam N. Musick ,&nbsp;Antonia F. Chen ,&nbsp;Nishant Suneja","doi":"10.1016/j.jcot.2025.103275","DOIUrl":"10.1016/j.jcot.2025.103275","url":null,"abstract":"<div><h3>Background</h3><div>Displaced femoral neck fractures in older adults are commonly treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA), with the choice influenced by patient characteristics, surgeon training, and logistical factors. Prior international studies suggest THA is more often performed on weekdays and by arthroplasty-trained surgeons, but it is unclear whether similar patterns exist in the United States. This study examines whether weekend surgery affects the choice between HA and THA after adjusting for patient and surgeon-specific factors.</div></div><div><h3>Methods</h3><div><strong><em>Design</em></strong>: Retrospective cohort.</div><div><strong><em>Setting</em></strong>: Two Level 1 Trauma Centers.</div><div><strong><em>Patient Selection Criteria</em></strong>: Adult patients with displaced femoral neck fractures (2001–2023) treated with HA or THA.</div><div><strong><em>Outcome Measures and Comparisons</em></strong>: The primary outcome was the relative proportion of HA versus THA performed on weekends versus weekdays. Secondary outcomes included perioperative factors associated with weekend surgery.</div></div><div><h3>Results</h3><div>Among 1947 cases, propensity matching yielded two well-balanced cohorts of 497 cases. Before matching, HA patients were older (80.4 vs. 70.9 years, p &lt; 0.0001), had lower BMI (24.6 vs. 25.4 kg/m², p = 0.002), and had a higher Elixhauser Comorbidity Index (25.5 vs. 15.3, p &lt; 0.0001). Surgeon subspecialty training differed between the cohorts and more experienced surgeons were more likely to choose THA (15.1 years vs. 13.0 years, p = 0.0004). After matching, weekend surgery was associated with higher HA rates (24.7 % vs. 18.7 %, p = 0.021), despite appropriately balanced patient and surgeon characteristics.</div></div><div><h3>Conclusions</h3><div>Weekend surgery is associated with higher rates of HA over THA in displaced FNFs, independent of patient and surgeon characteristics. These findings suggest potential system-level factors influencing surgical decision-making and highlight the need for further investigation into resource allocation, cognitive biases, and perioperative workflows.</div></div><div><h3>Mesh terms</h3><div>Arthroplasty, Replacement, Hip; Hip Fractures; Practice Patterns, Physician's; Propensity Score.</div></div><div><h3>Level of evidence</h3><div>Therapeutic Level IV.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103275"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624598","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":"Impact of posterior tibial slope on functional outcomes after mobile-bearing total knee arthroplasty","authors":"Tarun Jayakumar,&nbsp;Kushal Hippalgaonkar,&nbsp;Albin Savio,&nbsp;Chiranjeevi Thayi,&nbsp;AV.Gurava Reddy","doi":"10.1016/j.jcot.2025.103296","DOIUrl":"10.1016/j.jcot.2025.103296","url":null,"abstract":"<div><h3>Background</h3><div>Posterior tibial slope (PTS) is believed to influence range of motion (ROM) and functional outcomes after total knee arthroplasty (TKA), particularly in cruciate-retaining and posterior-stabilized designs. However, limited data exist on its impact in mobile-bearing systems. This study evaluated whether variations in PTS affect ROM and patient-reported outcome measures (PROMs) following mobile-bearing TKA using the Buechel-Pappas design.</div></div><div><h3>Methods</h3><div>This was a retrospective, single center cohort study on 359 patients who underwent cemented mobile-bearing TKA between 2018 and 2022, with a minimum follow-up of 2 years. Patients were stratified into three PTS categories: &lt;4°, 4–7°, and &gt;7° and analyzed. Functional outcomes were assessed using the Oxford Knee Score (OKS), Forgotten Joint Score (FJS), maximal knee ROM, and complications.</div></div><div><h3>Results</h3><div>Patient had a mean follow-up of 2.8 years (SD = 0.9) with a mean age was 61.3 (SD = 7.7) years. Baseline demographic characteristics were comparable between the 3 cohorts. Mean postoperative ROM improved significantly from 75.2° to 95.3°, and mean OKS from 16.2 to 34.5 (p &lt; 0.001). However, no significant differences in ROM, OKS, or FJS were observed between PTS groups (p &gt; 0.05). Analysis of change in PTS between pre-operative to post-operative showed no significant difference. ROC analyses and logistic regression demonstrated poor predictive ability of PTS for functional outcomes.</div></div><div><h3>Conclusion</h3><div>Variations in posterior tibial slope within typical clinical ranges (&lt;4°, 4–7°, &gt;7°), as well as the degree of change in slope achieved from preoperative to postoperative alignment, did not significantly affect postoperative range of motion or patient-reported outcomes following mobile-bearing total knee arthroplasty.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103296"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797000","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":"Meniscectomy before total knee arthroplasty increases the risk of all-cause revision and revision for infection: A national database analysis","authors":"Cole R. Johnson,&nbsp;Khaled A. Elmenawi,&nbsp;Ahmed K. Emara,&nbsp;Benjamin E. Jevnikar,&nbsp;Matthew E. Deren,&nbsp;Nicolas S. Piuzzi","doi":"10.1016/j.jcot.2025.103292","DOIUrl":"10.1016/j.jcot.2025.103292","url":null,"abstract":"<div><h3>Background</h3><div>Arthroscopic meniscectomy (AM) is a common procedure in middle-aged adults with degenerative meniscal tears. As many of these patients eventually require total knee arthroplasty (TKA), concerns have emerged regarding the potential impact of prior AM on TKA outcomes. This study evaluated whether a history of ipsilateral AM is associated with increased short- and mid-term complications following TKA.</div></div><div><h3>Methods</h3><div>Using the PearlDiver national database, adult patients who underwent primary TKA for osteoarthritis between 2016 and 2022 with 1-year of follow-up and laterality available were identified (n = 1,152,444). Patients with prior ipsilateral AM were matched 1:1 to controls without prior AM based on age, sex, comorbidities, and year of surgery (n = 40,341 per group). Multivariate logistic regression was used to evaluate 90-day healthcare utilization (emergency department visits, reoperations, and readmissions) and 1- and 2-year revision risks (all-cause, septic, and aseptic).</div></div><div><h3>Results</h3><div>Approximately 3.5 % of TKA patients had prior AM. Patients with prior AM had significantly higher rates of 90-day emergency department visits (OR, 1.23; 95 % CI, 1.18–1.29), reoperations (OR, 2.10; 95 % CI, 1.95–2.27), and readmissions (OR, 1.43; 95 % CI, 1.32–1.55) (all p &lt; 0.001). At 1-year post-TKA, these patients had increased odds of all-cause revision (OR, 2.47), revision for PJI (OR, 2.15), and aseptic revision (OR, 2.62). These risks remained elevated at 2 years: all-cause revision (OR, 2.83), revision for PJI (OR, 2.33), and aseptic revision (OR, 3.06) (all p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Prior ipsilateral AM is associated with significantly increased risks of short- and mid-term complications following primary TKA, including reoperations, readmissions, and both septic and aseptic revisions. These findings highlight the need for careful patient counseling and surgical planning in patients with a history of meniscectomy.</div></div><div><h3>Level of evidence</h3><div>Level III; Retrospective cohort study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103292"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797114","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":"Epidemiology and injury trends of acetabulum fractures including atypical fractures a tertiary care centre study in North India","authors":"Dharmendra Kumar ,&nbsp;Faisal Ahmad ,&nbsp;Madhusudan Mishra ,&nbsp;Rahul Kirti Sharma ,&nbsp;Vivek Kumar Verma ,&nbsp;Ashish Kumar","doi":"10.1016/j.jcot.2025.103241","DOIUrl":"10.1016/j.jcot.2025.103241","url":null,"abstract":"<div><h3>Background</h3><div>Acetabulum fractures are complex injuries that significantly affect the ability to mobilise and lead to an active quality of life. The study examined the epidemiological patterns, demographic characteristics, and classifications of acetabulum fractures, including atypical fractures, in a tertiary care centre in North India.</div></div><div><h3>Methods</h3><div>This prospective study was conducted from 2020 to 2024 among 344 patients diagnosed with acetabulum fractures. Demographics, injury patterns, socio-economic status, and classification of fractures were analysed. Trends and associations were statistically analysed.</div></div><div><h3>Results</h3><div>The mean age of patients is 36.04 ± 14.23 years, in which males have dominated the cases at 81.97 %. The leading cause of injury was due to road traffic accidents, accounting for 80.52 %. Major occupational groups affected included students (31.10 %), followed by farmers (21.80 %). Slightly more fractures occurred on the right side, 49.41 %, than on the left side, 46.22 %. Bilateral was 4.36 %. Both-column fracture types represented the highest with 20.63 %, ACPHT fracture with 18.89 %, and the fracture of the posterior wall with 18.31 %. Atypical fracture patterns were identified in 3.48 % of cases. The time taken to go to surgery averaged 6.77 ± 3.73 days, with an average length of stay at the hospital of 13.71 ± 7.18.</div></div><div><h3>Conclusion</h3><div>This study highlights acetabulum fractures in young males from road traffic accidents, with atypical fractures requiring advanced strategies. Their timely intervention and prevention policies may ensure better outcomes for them.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103241"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321979","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":"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":"2025-12-01","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":"Is guided growth a viable treatment option for angular deformity correction in distal renal tubular acidosis patients?","authors":"Siddharth Jain ,&nbsp;Prateek Behera ,&nbsp;Girish Chandra Bhatt ,&nbsp;Sourabh Kumar Sinha ,&nbsp;Vikas Gupta ,&nbsp;Ajai Singh","doi":"10.1016/j.jcot.2025.103260","DOIUrl":"10.1016/j.jcot.2025.103260","url":null,"abstract":"<div><h3>Background</h3><div>Distal renal tubular acidosis (dRTA) is a rare disorder marked by impaired hydrogen ion secretion in the distal nephron, leading to metabolic acidosis and skeletal manifestations resembling rickets. While medical treatment with alkali, calcium, and vitamin D supplementation is essential, severe coronal plane knee deformities may necessitate surgical correction. Traditional osteotomy is an invasive modality, and data on less invasive options such as guided growth with eight-plate hemiepiphysiodesis in dRTA is limited.</div></div><div><h3>Methods</h3><div>This retrospective study included seven children (6 males, 1 female; mean age: 11 years) of dRTA who underwent growth modulation with eight-platesfor genu valgum between 2019–2024 concurrently with medical management. Rate of angular deformity correction based on time interval between 8 plate placement and removal, and postoperative complications were recorded.</div></div><div><h3>Results</h3><div>Six patients had distal femoral involvement and one had proximal tibial deformity. Correction was achieved in all cases, with no implant-related complications. The average rate of angular correction was 1.18°/month (range: 0.71–1.84°) in distal femoral cases and 0.54°/month (range: 0.52–0.56°) in the tibial case. One patient required staged implant removal due to initial difference in severity of deformity. No rebound deformity or recurrence was noted till last follow-up.</div></div><div><h3>Conclusion</h3><div>Concurrent medical management and growth modulation using 8 plate is a feasible option for management of angular deformities in children with active distal renal tubular acidosis. This approach may reduce or eliminate the need for osteotomy, offering a less invasive alternative with promising outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103260"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520202","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":"Craniocervical traumatic ligamentous injuries – AO spine type B injuries – Anatomy, biomechanics and clinical perspectives","authors":"Andrei Fernandes Joaquim ,&nbsp;Klaus John Schnake ,&nbsp;Richard J. Bransford ,&nbsp;Harvinder Singh Chabbra ,&nbsp;Sebastian F. Bigdon ,&nbsp;Mohammad El-Sharkawi ,&nbsp;Gregory D. Schroeder","doi":"10.1016/j.jcot.2025.103223","DOIUrl":"10.1016/j.jcot.2025.103223","url":null,"abstract":"<div><div>The craniocervical junction (CCJ) relies on strong ligamentous structures to maintain stability, which can be compromised by traumatic injuries. Defining stability is critical for selecting operative or non-operative management. This review summarizes the anatomy, imaging, and biomechanical relevance of the main CCJ ligaments, with emphasis on type B injuries in the AO Spine Upper Cervical Classification. Current evidence suggests that neurologically intact patients with normal CT scans (occipitoatlantal joints) and mild MRI abnormalities may be treated conservatively, with fluoroscopic traction testing serving as a supportive tool. Considering C1-2 ligamentous injuries, transverse ligament injury (TL), however, often requires an MRI for accurate diagnosis, particularly in association with atlas lateral mass fractures. While surgical treatment may provide advantages in pain and function, non-operative strategies remain appropriate in selected cases. When surgery is indicated, C1 ORIF is a feasible alternative to C1-2 fusion in patients with TL rupture, also considering an intraoperative test for abnormal motion at C1-2.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103223"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145271265","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":"Predictive variables influencing intraoperative blood loss during single-stage posterior spinal fusion in severe idiopathic scoliosis: Analysis of 126 cases","authors":"Y. Mihara ,&nbsp;S.Y. Lee ,&nbsp;C.Y.W. Chan ,&nbsp;C.K. Chiu ,&nbsp;M.S. Hasan ,&nbsp;M.K. Kwan","doi":"10.1016/j.jcot.2025.103248","DOIUrl":"10.1016/j.jcot.2025.103248","url":null,"abstract":"<div><h3>Background</h3><div>Despite the clinical importance, few studies have specifically addressed intraoperative blood loss in patients with severe idiopathic scoliosis undergoing posterior spinal fusion (PSF). Therefore, this study seeks to investigate independent predictors of intraoperative bleeding during single-stage PSF in this high-risk population.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 126 patients with severe IS (defined as a major Cobb angle ≥90°) who underwent single-stage PSF without osteotomy procedures. Key parameters collected included preoperative Cobb angle (Pre Cobb), postoperative Cobb angle (Post Cobb), correction rate (CR), side-bending Cobb angle (SB Cobb), side-bending flexibility (SBF), side-bending correction index (SBCI), total number of fusion levels, number of pedicle screws utilized, and operative time (Op Time). The estimated total intraoperative blood loss (EBL) was quantified. Multiple regression analysis was employed to identify independent predictors of intraoperative blood loss.</div></div><div><h3>Results</h3><div>The mean pre Cobb was 103.0 + 12.4^° and post Cobb was 45.1 + 14.0°. The mean CR was 56.1 + 12.8 %. The mean SB Cobb and flexibility were 65.0 + 19.4^° and 37.7 + 13.7 %. Average SBCI was 1.8 + 1.2. The mean fusion levels and number of screws used were 13.3 + 1.3 and 16.3 + 1.6, respectively. The mean Op time in this study was 185.9 + 49.3 min. The mean EBL was 1493.0 + 841.0 mL, EBL/EBV ratio was 51.6 + 29.1 %, and EBL/level fused was 112.0 ± 62.0 mL. Multiple regression analysis identified Op time, gender, and pre Cobb as the independent predictors for EBL (R² 0.281; <em>p</em> &lt; 0.05). The derived predictive formula was EBL = −1747.0 + (5.6 x Op time) + (13.9 x pre Cobb) + (697.0 x G), where G = 2 for male and G = 1 for female.</div></div><div><h3>Conclusions</h3><div>Operative time, male gender, and preoperative major Cobb angle were the significant predictive factors for EBL in single-stage PSF surgery for severe IS patients.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103248"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466683","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":"Elastic stable intramedullary nailing for pediatric forearm fractures: A review article","authors":"Esha Reddy ,&nbsp;Aakanksha Sriwastwa ,&nbsp;Saral Patel ,&nbsp;Rajul Gupta ,&nbsp;Shital N. Parikh","doi":"10.1016/j.jcot.2025.103249","DOIUrl":"10.1016/j.jcot.2025.103249","url":null,"abstract":"<div><div>Fractures of the shaft of the radius and ulna are common injuries in children and adolescents. Undisplaced fractures and fractures that are stable after closed reduction, can be treated with cast immobilization and an interosseous mold. Healing is reliable in children and remodeling would help to correct any residual malunion at the fracture site. However, in older children and adolescents, where the healing and remodeling potential is limited, and for unstable fractures, surgical intervention may be necessary. Intramedullary nailing using elastic nails, also known as elastic stable intramedullary nailing (ESIN) is the gold standard for surgical treatment of forearm fractures in children and adolescents, as it is physeal-sparing, safe, reliable and minimally invasive. There are several pearls and pitfalls related to the surgical technique of ESIN which would be discussed in this article. It does require a second surgery for removal of the nails once fracture is healed. The overall outcomes of ESIN of forearm shaft fracture are very satisfactory. Most of the complications are technique-related and can be avoided by meticulous attention to details. The aim of this narrative review article is to provide an overview of the indications, surgical techniques, clinical outcomes and potential complications of ESIN of forearm shaft fractures. It is important for orthopaedic surgeons who treat these fractures in children to master the art of ESIN.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103249"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417840","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}