Joint diseases and related surgery最新文献

{"title":"High diagnostic accuracy of a resnet50-based deep learning model for osteochondral lesions of the talus on magnetic resonance imaging.","authors":"Sultan Mujib Dabiry, Yunus Demirtaş, Fuat Türk, Tuğrul Yıldırım, Gökhan Ayık, Gökhan Çakmak","doi":"10.52312/jdrs.2026.2719","DOIUrl":"10.52312/jdrs.2026.2719","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the diagnostic performance of a ResNet50-based convolutional neural network (CNN) in detecting osteochondral lesions of the talus (OLTs) on magnetic resonance imaging (MRI) and to compare its efficacy between T1- and T2- weighted sequences.</p><p><strong>Materials and methods: </strong>A total of 219 ankle MRI scans were reviewed retrospectively, including 60 with confirmed OLTs and 159 without lesions. From each study, coronal and sagittal T1- and T2-weighted images were extracted and standardized to 224 × 224 pixels. Augmentation techniques were applied to strengthen model training. Data were divided into training, validation, and test sets in a 60:20:20 split. A ResNet50 model initialized with ImageNet weights was fine-tuned using crossentropy loss with class weighting. Diagnostic performance was summarized with accuracy, precision, recall, and F1-scores.</p><p><strong>Results: </strong>The model performed better on T1 sequences, achieving an accuracy of 94.1% (95% confidence interval [CI] 88.3-97.1%) and an area under the curve [AUC] of 0.93 (95% CI 0.87-0.97), with patient cases classified at 0.92 precision and 0.82 recall. Healthy controls in the T1 group were recognized with 0.95 precision and 0.98 recall. In contrast, T2 sequences were less reliable, showing an accuracy of 87.2% (95% CI 80.5-91.9%) and an AUC of 0.91 (95% CI 0.85-0.95). Precision for patient cases in the T2 group was notably lower (0.65) despite a recall of 0.81. Misclassifications were more frequent in the T2 dataset, as evidenced by the confusion matrices.</p><p><strong>Conclusion: </strong>Even with a relatively modest dataset, the ResNet50 model delivered strong results for T1-weighted MRI. While T2 images proved more challenging, suggesting that deep learning can add value to routine assessment of OLTs.</p>","PeriodicalId":73560,"journal":{"name":"Joint diseases and related surgery","volume":"37 2","pages":"543-551"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for persistent wound drainage after hemiarthroplasty in elderly hip fracture patients.","authors":"Zekeriya Ersin Çelen, Ali Utkan, Cem Cüneyt Köse, Olgun Bingöl, Bülent Özkurt","doi":"10.52312/jdrs.2026.2591","DOIUrl":"10.52312/jdrs.2026.2591","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the risk factors for persistent wound drainage (PWD) and its impact on in-hospital outcomes among geriatric patients with hip fractures treated with hemiarthroplasty.</p><p><strong>Patients and methods: </strong>A total of 265 hip fracture patients (91 males, 174 females; median age: 83 years; range, 65 to 99 years) who underwent hip hemiarthroplasty between June 2019 and June 2025 were retrospectively analyzed. Demographics, comorbidities, laboratory findings, and preoperative medications were evaluated. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of PWD.</p><p><strong>Results: </strong>Sixty-one (23.0%) patients were diagnosed with PWD. Low postoperative Day 1 serum albumin level (odds ratio [OR]= 0.85, 95% confidence interval [CI] 0.79-0.92, p < 0.001), preexisting hypertension (OR = 2.50, 95% CI 1.15-5.39, p = 0.020), and chronic warfarin use (OR = 8.15, 95% CI 2.20-30.14, p = 0.002) were identified as independent predictors of PWD. The optimal cut-off for the postoperative Day 1 serum albumin level was 30.5 g/L (sensitivity: 60.7%, specificity: 76.5%). In the PWD group, in-hospital mortality rates (16.4% vs. 5.9%, p = 0.009), mean length of hospital stay (17.7 ± 11.8 days vs. 7.4 ± 6.3 days, p = 0.000), and the incidence of sacral decubitus ulcers (26.2% vs. 10.8%, p = 0.003) were significantly higher. Rates of both superficial and deep wound infections were also significantly elevated in the PWD group (p < 0.001 and p = 0.003, respectively).</p><p><strong>Conclusion: </strong>Low postoperative albumin, preexisting hypertension, and chronic warfarin use are significant predictors of PWD following hemiarthroplasty in elderly patients with hip fractures, and the existence of PWD was associated with increased in-hospital morbidity and mortality. Early identification and preventive strategies targeting at-risk patients may improve outcomes.</p>","PeriodicalId":73560,"journal":{"name":"Joint diseases and related surgery","volume":"37 2","pages":"413-421"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrous dysplasia: Clinical features, deformities, management, and outcomes.","authors":"Mustafa Onur Karaca, Mustafa Özyıldıran, Mahmut Kalem, Yunus Şamil Gönüldenk, Kerem Başarır, Hüseyin Hakan Kınık, Hüseyin Yusuf Yıldız","doi":"10.52312/jdrs.2026.2633","DOIUrl":"10.52312/jdrs.2026.2633","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to evaluate the rate of proximal femoral involvement and the incidence of shepherd's crook deformity in patients with fibrous dysplasia (FD) and to identify possible factors associated with the development of shepherd's crook deformity.</p><p><strong>Patients and methods: </strong>Between January 1990 and December 2022, a total of 158 consecutive patients (78 males, 80 females; mean age: 23.8 ± 15.0 years; range, 3 to 71 years) diagnosed with FD were retrospectively analyzed. Presenting symptoms, lesion location, radiological findings, treatment modalities, development of deformity, postoperative complications, and the need for secondary surgery were recorded.</p><p><strong>Results: </strong>The mean follow-up was 64.2 ± 38.4 (range, 24 to 210) months. Among the patients, 125 had monostotic and 33 had polyostotic lesions. Of the 215 lesions identified, 83 were treated surgically, while 132 were managed with clinical observation. Shepherd's crook deformity was observed in nine of 75 proximal femoral lesions. The deformity was significantly more common in polyostotic than in monostotic lesions (25.0% vs. 5.9% respectively; p = 0.026). McCune-Albright syndrome (MAS) was present in two patients, both exhibiting shepherd's crook deformity, whereas the rate was 9.6% among patients without MAS. Valgus osteotomy was performed in all nine patients with shepherd's crook deformity, improving the mean neck-shaft angle from 90.5° (range, 85 to 105°) preoperatively to 125.6° (range, 120 to 130°) postoperatively. In six of these patients, no marked loss in the postoperative neck-shaft angle was observed, while three patients required secondary surgery due to recurrence of the deformity.</p><p><strong>Conclusion: </strong>Most lesions can be managed successfully with observation, while surgery is indicated for the eradication of symptomatic lesions, prevention of pathological fractures, and correction of deformities. Shepherd's crook deformity seems to be more common in patients with polyostotic lesions and MAS. Although valgus osteotomy can achieve radiographic improvement, recurrence of deformity and the need for multiple surgeries are not uncommon.</p>","PeriodicalId":73560,"journal":{"name":"Joint diseases and related surgery","volume":"37 2","pages":"531-542"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-specific 3D printed guides for repairing posterior root tears of the medial meniscus: A cadaveric study.","authors":"María Durán-Serrano, Ignacio Colom-Diaz, Antonio-Francisco Laclériga-Giménez, Daniel Delfau-Lafuente, Adrián Roche-Albero, Miguel Lizcano-Palomares, Carlos Martín-Hernández","doi":"10.52312/jdrs.2026.2233","DOIUrl":"10.52312/jdrs.2026.2233","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to evaluate the accuracy of tibial tunnel placement using patient-specific three-dimensional (3D)-printed guides for repairing medial meniscus posterior root tears designed from magnetic resonance imaging (MRI) scans.</p><p><strong>Materials and methods: </strong>Five right fresh-frozen cadaveric knees underwent MRI scanning with 1-mm isotropic slices. For each specimen, custom guides were created to generate two transosseous tibial tunnels, with design based on anatomical landmarks including the medial tibial eminence (MTE) and the posterior cruciate ligament (PCL) insertion. Guide design was done using Rhinoceros software, segmentation of bone structures and soft tissues in 3D Slicer, and printing in polyamide. After arthroscopic repair, computed tomography scans and anatomical dissections were performed to measure the accuracy of tunnel placement relative to the native medial meniscus posterior root attachment (MMPRA), the MTE, and the PCL. Individual pre- and postoperative measurements were compared to verify anatomical accuracy, and pooled data from all knees were analyzed.</p><p><strong>Results: </strong>Individual evaluation showed minimal differences between pre- and postoperative measurements, ranging from 0.00 to 0.09 mm. Pooled analysis revealed no significant differences in the measurements taken: PCL-MMPRA (p = 0.313), MTEMMPRA (p = 0.705) or the width of MMPRA (p = 0.125). The guides enabled precise and reproducible tunnel placement, with consistent targeting of the anatomical footprint. Each guide cost approximately €30, with a production turnaround time of less than one week.</p><p><strong>Conclusion: </strong>Patient-specific 3D-printed guides enable the effective creation of two anatomically accurate tibial tunnels for medial meniscus posterior root repair. This approach offers a rapid and precise solution for anatomical restoration using MRI-guided planning.</p>","PeriodicalId":73560,"journal":{"name":"Joint diseases and related surgery","volume":"37 2","pages":"306-313"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hidden blood loss in total hip arthroplasty: A comparison of the direct anterior versus posterolateral approach.","authors":"Jian-Wei Zeng, Xin Chen, Yun-Jie Wang, Xie Jiang, Xiao-Ke Yao","doi":"10.52312/jdrs.2026.2642","DOIUrl":"10.52312/jdrs.2026.2642","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to compare the volume and impact of hidden blood loss (HBL) following total hip arthroplasty (THA) performed via the direct anterior approach (DAA) versus the posterolateral approach (PLA).</p><p><strong>Patients and methods: </strong>Between January 2016 and January 2024, a total of 134 patients (63 males, 71 females; mean age: 69.7 ± 7.7 years; range, 48 to 79 years) who underwent primary THA were retrospectively analyzed. The patients were stratified into two cohorts according to surgical approach: DAA group (n = 63) and PLA group (n = 71). Preoperative blood volume and visible blood loss (VBL) were quantified for both cohorts. Total blood loss (TBL) was derived from hematocrit (Hct) levels measured preoperatively and on postoperative Day 3, which subsequently allowed calculation of HBL and its proportion relative to TBL. Intergroup comparisons were performed for these parameters.</p><p><strong>Results: </strong>The most common etiology for THA was hip osteoarthritis. The mean operative time was 120.4 ± 10.2 min in the DAA group and 117.7 ± 8.2 min in the PLA group, indicating no statistically significant difference between the two groups (p = 0.093). The mean TBL was 366.3 ± 54.3 mL in the DAA group and 477.0 ± 71.6 mL in the PLA group (p < 0.001), while the mean HBL was 206.3 ± 40.4 mL and 318.9 ± 44.9 mL, respectively (p < 0.001). The reductions in Hb and Hct were significantly lower in the DAA group compared to the PLA group (p < 0.001 for both).</p><p><strong>Conclusion: </strong>During the perioperative period of THA, HBL represents a considerable clinical concern regardless of the surgical approach employed. Compared to the PLA, the DAA is associated with a significant reduction in both HBL and TBL.</p>","PeriodicalId":73560,"journal":{"name":"Joint diseases and related surgery","volume":"37 2","pages":"344-350"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of hidden blood loss between the Wiltse approach with pedicle screw fixation and the percutaneous pedicle screw fixation for neurologically intact thoracolumbar fractures.","authors":"Ding Hu, Yu He, Yin-Xiao Peng, Shanchuan Wei","doi":"10.52312/jdrs.2026.2556","DOIUrl":"10.52312/jdrs.2026.2556","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to quantify hidden blood loss (HBL) associated with minimally invasive pedicle screw placement and to compare HBL between the Wiltse approach and percutaneous pedicle screw techniques.</p><p><strong>Patients and methods: </strong>Between January 2020 and December 2022, a total of 126 neurologically intact patients (63 males, 63 females; mean age: 43.0 ± 11.5 years; range, 18 to 65 years) with single-segment traumatic thoracolumbar fractures who underwent surgery were retrospectively analyzed. The patients were categorized into two groups based on surgical technique: the study group (Wiltse approach) and control group (percutaneous pedicle screw). Demographic and clinical data were collected. Perioperative laboratory values were recorded, and HBL was calculated using a combination of the Nadler, Gross, and Sehat formulas.</p><p><strong>Results: </strong>The Wiltse approach group demonstrated a significantly shorter surgical time and fewer intraoperative fluoroscopy uses compared to the percutaneous group (p < 0.001 for both). Although intraoperative visible blood loss (VBL) was higher in the Wiltse group (p < 0.001), this group showed a smaller postoperative hemoglobin loss (p = 0.025) and significantly less HBL in absolute volume (p=0.031).</p><p><strong>Conclusion: </strong>In minimally invasive surgery for single-segment thoracolumbar fractures, perioperative HBL considerably exceeds VBL. Compared to the Wiltse approach, percutaneous pedicle screw fixation is associated with longer operation time, greater radiation exposure, and higher HBL. Therefore, spine surgeons should emphasize close monitoring of postoperative hemoglobin and appropriate management of anemia in patients undergoing percutaneous instrumentation.</p>","PeriodicalId":73560,"journal":{"name":"Joint diseases and related surgery","volume":"37 2","pages":"291-298"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral open-door laminoplasty alone with and without foraminoplasty for the treatment of mixed cervical spondylosis.","authors":"Yong-An Ren, Yin-Xiao Peng, Cong-Jun Ding, Ying Yang, Rong-Hui Tang, Ya-Li Kang","doi":"10.52312/jdrs.2026.2583","DOIUrl":"10.52312/jdrs.2026.2583","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to compare the clinical outcomes of unilateral open-door laminoplasty with adjunctive foraminoplasty in the management of mixed cervical spondylosis.</p><p><strong>Patients and methods: </strong>Between January 2016 and January 2024, a total of 60 patients (36 males, 24 females; mean age: 71.8 ± 9.9 years; range, 52 to 92 years) who were diagnosed with mixed cervical spondylosis and underwent unilateral open-door laminoplasty were retrospectively analyzed. The patients were divided into two groups: Group A (n = 30) received laminoplasty alone and Group B (n = 30) underwent laminoplasty combined with foraminoplasty. Demographic data, perioperative outcomes, clinical efficacy, and complication rates were compared between the two groups.</p><p><strong>Results: </strong>Group A showed significantly shorter operative time and reduced intraoperative blood loss compared to Group B (p < 0.001). Both groups exhibited significant improvements over time in Visual Analog Scale (VAS) scores for neck and upper limb pain (p < 0.05) and Japanese Orthopaedic Association (JOA) scores (p < 0.05). At the final follow-up, Group B demonstrated superior JOA scores and lower VAS scores for both neck and upper limb pain relative to Group A (p < 0.05). The incidence of postoperative C5 nerve root palsy and persistent upper limb radicular pain was significantly higher in Group A than in Group B (p < 0.05).</p><p><strong>Conclusion: </strong>For patients with mixed cervical spondylosis, combining unilateral open-door laminoplasty with foraminoplasty provides effective concurrent decompression of the spinal cord and nerve roots, resulting in a significant symptomatic improvement in both myelopathic and radicular manifestations with a reduced risk of certain postoperative neurological complications.</p>","PeriodicalId":73560,"journal":{"name":"Joint diseases and related surgery","volume":"37 2","pages":"299-305"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ankle arthrodesis with arthroscopic fibular osteotomy for varus ankle arthritis.","authors":"Mehmet Orçun Akkurt, Batuhan Bahadir, Nurettin Mantı","doi":"10.52312/jdrs.2026.2680","DOIUrl":"10.52312/jdrs.2026.2680","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The aim of this study was to assess the clinical outcomes of a novel, single-stage arthroscopic ankle arthrodesis employing complete arthroscopic fibular osteotomy in patients exhibiting significant varus malalignment (≥ 10°) and severe osteoarthritis (OA) and to compare these results with those of patients undergoing arthroscopic ankle arthrodesis with mild deformity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;Between August 2018 and May 2023, a total of 49 patients (23 males, 26 females; mean age: 50.00 ± 14.72 years; range, 21 to 71 years) who underwent arthroscopic ankle arthrodesis for tibiotalar arthrosis with a minimum postoperative follow-up of two years were retrospectively analyzed. The patients were divided into two groups: Group A (n = 20) consisted of end-stage tibiotalar OA patients with ≥ 10° varus alignment and Group B (n = 29) consisted of those with &lt; 10° varus alignment. An arthroscopic fibular osteotomy at the level of ankle joint was performed using an osteotome introduced through the anteromedial portal in Group A, resulting in fibula shortening equivalent to the thickness of the osteotome. Fixation in both groups was achieved using two or three 6.5-mm cannulated screws. Outcomes were evaluated utilizing the Visual Analog Scale (VAS) for pain, the 36-item Short Form Survey (SF-36), and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) at baseline and at three, six, 12, and 24 months postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There was no statistically significant difference between the groups in terms of age, sex, or the affected sides between the groups (p = 0.210, p = 0.348, and p = 0.906, respectively). All the patients had Takakura Stage IIIB and IV ankle OA with a trauma-related etiology. The mean duration of the operation was 85.50±9.72 min in Group A which included arthroscopic fibular osteotomy and 57.59 ± 5.61 min in Group B, indicating a statistically significant difference (p &lt; 0.001). The mean fusion times and complication rates were comparable between the groups (p = 0.064 and p = 1.000, respectively). All patients demonstrated significant and consistent improvements in VAS, AOFAS, and SF-36 scores, compared to baseline (p &lt; 0.001). At three months, the VAS scores in Group A were significantly higher (p=0.020); however, later evaluations showed comparable scores between the groups. Group B exhibited significantly higher AOFAS scores at three, six, and 24 months. The SF-36 scores indicated no significant differences between the groups in any time points in the postoperative period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study provides the novel, initial clinical evidence for a single-stage arthroscopic procedure which incorporates complete arthroscopic ankle arthrodesis and arthroscopic fibular osteotomy in severe varus deformities. It can be effectively used with similar fusion and recovery times, by eliminating mechanical obstruction caused by ","PeriodicalId":73560,"journal":{"name":"Joint diseases and related surgery","volume":"37 2","pages":"442-453"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual reduction combined with percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures.","authors":"Dong-Zhe Li, Yu He, Zhao-Kui Yan, Tai-Ping Wang, Yong Zeng","doi":"10.52312/jdrs.2026.2652","DOIUrl":"10.52312/jdrs.2026.2652","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to compare manual reduction combined with percutaneous vertebroplasty (PVP) versus percutaneous kyphoplasty (PKP) for the treatment of fresh (≤ 3 weeks post-injury), single-segment osteoporotic vertebral compression fractures (OVCFs).</p><p><strong>Patients and methods: </strong>Between January 2021 and January 2024, a total of 136 patients (46 males, 90 females; mean age: 76.8 ± 8.4 years; range, 60 to 94 years) with thoracolumbar OVCFs who underwent vertebral augmentation were retrospectively analyzed. The patients were assigned to either Group 1 (manual reduction + PVP, n = 60) or Group 2 (PKP alone, n = 76). Operative time, fluoroscopy frequency, cement volume, cement leakage, cement distribution, anterior vertebral height (AVH), kyphotic Cobb angle, and Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were compared.</p><p><strong>Results: </strong>Compared to Group 2, Group 1 showed significantly shorter operative time (29.2 ± 5.1 min vs. 32.4 ± 8.2 min, p < 0.05), fewer intraoperative fluoroscopy scans (18.9 ± 1.7 vs. 21.9 ± 3.0, p < 0.05), greater cement volume (4.9 ± 0.8 mL vs. 4.0 ± 0.7 mL, p < 0.05), and a higher proportion of favorable cement distribution (80.0% vs. 56.6%, p < 0.05). Cement leakage rates were comparable (21.7% vs. 18.4%, p > 0.05). Although preoperative parameters were similar between the groups, Group 1 achieved significantly better postoperative AVH (23.1 ± 2.2 mm vs. 20.4 ± 2.6 mm, p < 0.05), kyphotic Cobb angle (8.5 ± 1.9° vs. 10.6 ± 1.9°, p < 0.05), and ODI scores (19.0 [18.0, 21.0] vs. 21.0 [19.0, 23.0], p = 0.001) compared to Group 2. Postoperative VAS scores showed no significant difference between the groups (2.0 [2.0, 3.0] vs. 2.0 [2.0, 3.0], p = 0.354). Both groups exhibited significant postoperative improvements in all clinical outcomes (p < 0.05).</p><p><strong>Conclusion: </strong>Although both techniques effectively relieve pain and correct deformity, manual reduction combined with PVP offers more favorable radiographic restoration, improved functional outcomes, shorter operation time, and less radiation exposure compared to PKP.</p>","PeriodicalId":73560,"journal":{"name":"Joint diseases and related surgery","volume":"37 2","pages":"381-389"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing fixation in medial distal femur fractures: A biomechanical study.","authors":"Atahan Durgal, Enver Kilic, Elif Naz Perdeci, Fatma Kubra Erbay Elibol, Taner Karlidag, Burak Kulakoglu, Teyfik Demir, Olgun Bingol, Guzelali Ozdemir","doi":"10.52312/jdrs.2026.2543","DOIUrl":"10.52312/jdrs.2026.2543","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to biomechanically compare four fixation methods to identify the most stable construct under axial loading conditions.</p><p><strong>Material and methods: </strong>A standardized osteotomy model simulating AO/OTA 33-B2.1 fractures was created in 28 synthetic femurs. Four groups (n = 7 each) were tested: (1) three 6.5-mm cannulated screws, (2) the same with an additional centrally placed screw, (3) three screws plus a 3.5-mm buttress plate, and (4) three screws combined with a reversed anatomical proximal tibial locking plate. Constructs were subjected to cyclic and static axial loading. The prespecified primary endpoint was load at 2-mm displacement, with stiffness and maximum load to failure as secondary outcomes.</p><p><strong>Results: </strong>Group 4 exhibited the highest stiffness (802 ± 70 N/mm), maximum load (2360 ± 389 N), and resistance to 2-mm displacement (1138 ± 87 N). Group 2, with a centrally placed fourth screw, showed significantly improved performance in terms of maximum load compared to the traditional three-screw construct. While Group 3 improved stiffness over screw-only constructs, it did not significantly outperform Group 2 in key load metrics. Group 2, with a centrally placed fourth screw, demonstrated comparable stability to the buttress plate and anatomical locking plate in selected metrics, but remained inferior to the locking plate construct.</p><p><strong>Conclusion: </strong>Central placement of cannulated screws to the medial femoral condyle enhanced axial stability in this synthetic model and represented a minimally invasive alternative to buttress plating in selected metrics. The highest stability was achieved with the combined use of cannulated screws and a locking plate. These results are restricted to axial loading and the tested endpoints; thus, further biomechanical, cadaveric, and clinical studies are warranted before generalizing to early weight-bearing. Given the anatomical challenges of the medial condyle, the development of anatomically contoured locking plates specifically designed for this region remains an important future direction.</p>","PeriodicalId":73560,"journal":{"name":"Joint diseases and related surgery","volume":"37 2","pages":"489-500"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}