Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Can ChatGPT pass the polish national medical specialization examination in orthopedics and traumatology?","authors":"Bartosz Maciąg,&nbsp;Krzysztof Bujak,&nbsp;Dawid Jegierski,&nbsp;Artur Stolarczyk","doi":"10.1007/s00402-026-06435-9","DOIUrl":"10.1007/s00402-026-06435-9","url":null,"abstract":"<div><h3>Introduction</h3><p>Artificial intelligence (AI) has evolved rapidly in recent years and is becoming increasingly integrated into many areas of medicine. In the medical field, these systems have attracted considerable attention because of their potential applications in clinical decision support, medical education, scientific communication, and postgraduate training. The aim of the present study was to evaluate whether ChatGPT could achieve a passing score on the Polish National Medical Specialization Examination (Panstwowy Egzamin Specjalizacyjny, PES) in orthopedics and traumatology and to determine how different prompting strategies influenced its performance.</p><h3>Materials and methods</h3><p>Authors systematically assessed the performance of ChatGPT-4 across five consecutive official PES exams (from Autumn 2023 to Spring 2025) in orthopedics and traumatology. Each exam was administered using three distinct prompting strategies: Professor prompt, Specialist prompt, Resident prompt. For each exam session (e.g., Spring 2024, Autumn 2023), the prompts were submitted to ChatGPT sequentially. The model’s responses were evaluated against the official answer key published by the Polish Center of Medical Exams (Centrum Egzaminów Medycznych, CEM).</p><h3>Results</h3><p>The results were averaged across all prompts. The overall accuracy was 81% (range: 68.33%–85.83%). The highest score (85.83%) was recorded multiple times across different prompt types, indicating that the model could approach or exceed the minimum passing threshold depending on prompt structure. Agreement between prompting strategies was moderate to substantial (Cohen’s κ 0.518–0.632; Fleiss’ κ = 0.571). Radiology-related questions demonstrated the highest error rate among all question categories.</p><h3>Conclusions</h3><p>Large language models such as ChatGPT can perform well on knowledge-based orthopedic examinations and may serve as useful tools for examination preparation and educational support. However, examination success should not be interpreted as evidence of clinical competence or readiness for independent surgical practice. Specialist certification and patient care remain dependent on human expertise, practical skills, and professional responsibility.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06435-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with selection of total hip arthroplasty versus hemiarthroplasty for femoral neck fracture in older adults: a nationwide analysis of 99,084 cases","authors":"David Maman,&nbsp;Yaniv Steinfield,&nbsp;Yaron Berkovich","doi":"10.1007/s00402-026-06459-1","DOIUrl":"10.1007/s00402-026-06459-1","url":null,"abstract":"<div><h3>Background</h3><p>Surgical management of displaced femoral neck fractures in older adults typically involves hemiarthroplasty or total hip arthroplasty (THA). Although clinical guidelines suggest that THA may be considered in selected healthier and cognitively intact patients, real-world procedure selection varies widely. This study evaluated patient factors associated with selection of THA versus hemiarthroplasty in a contemporary U.S. dataset.</p><h3>Methods</h3><p>A retrospective cohort study was conducted using the 2022 Nationwide Readmissions Database (NRD). Patients ≥ 65 years hospitalized with femoral neck fracture were identified using ICD-10-CM codes. Those treated with internal fixation or non-arthroplasty procedures were excluded. Weighted analyses characterized demographics, comorbidities, and hospital utilization between THA and hemiarthroplasty groups. A multivariable logistic regression model identified factors independently associated with receiving THA. All analyses accounted for NRD survey design.</p><h3>Results</h3><p>Among 142,013 operative cases, 99,084 met inclusion criteria (81.8% hemiarthroplasty; 18.2% THA). Patients receiving THA were younger (76.6 vs. 81.9 years), had shorter length of stay (6.06 vs. 7.24 days), and were more frequently discharged home (17.5% vs. 6.2%). Metabolic conditions were associated with increased odds of THA, including obesity (OR 1.17) and sleep apnea (OR 1.12). Frailty-related conditions were associated with markedly reduced THA likelihood, including Alzheimer’s disease (OR 0.48), Parkinson disease (OR 0.55), chronic kidney disease (OR 0.78), chronic lung disease (OR 0.72), and congestive heart failure (OR 0.77). Each additional year of age decreased the odds of THA by approximately 9%.</p><h3>Conclusion</h3><p>In this nationwide cohort, selection of THA rather than hemiarthroplasty was associated with younger age and lower prevalence of frailty- and cognition-related comorbidities, while several metabolic comorbidities showed modest positive associations with THA use. These findings describe contemporary national selection patterns but do not establish treatment appropriateness, clinical benefit, or guideline concordance, as key factors such as pre-fracture mobility, functional independence, and living situation were not available in the dataset.</p><h3>Level of evidence</h3><p>Level III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06459-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-year outcomes following concomitant ACL and extra-articular ligament reconstruction: a nationwide analysis of over 5,000 patients","authors":"Rayyan Abid,&nbsp;Robert J. Burkhart,&nbsp;Andrew J. Moyal,&nbsp;Jeremy M. Adelstein,&nbsp;Mark Kodsy,&nbsp;Jacob G. Calcei,&nbsp;James E. Voos,&nbsp;John M. Apostolakos","doi":"10.1007/s00402-026-06422-0","DOIUrl":"10.1007/s00402-026-06422-0","url":null,"abstract":"<div><h3>Purpose</h3><p>The anterior cruciate ligament (ACL) is the most commonly injured and reconstruction ligament in the United States. Associated injuries are common, oftentimes including components of the extra-articular knee. However, complications following concomitant ACL and extra-articular ligaments (EAL) has not been defined in a large-scale, population-based sample. We aimed to analyze outcomes following concomitant ACL and EAL reconstruction using the TriNetX nationwide database.ep</p><h3>Methods</h3><p>Deidentified data from the TriNetX Collaborative Network was used to identify all patients who received ACL and EAL reconstruction on the same day. Demographic information including age, sex, race, and geographic data were collected. Rates of medical and orthopaedic complications were analyzed at 30, 90, and 180 days and at 2 years. A propensity matched sub-analysis comparing outcomes patients with concomitant and staged repair was performed. Patients were identified using Current Procedural Terminology (CPT) coding.</p><h3>Results</h3><p>We identified 5944 patients who received concomitant ACL and EAL reconstruction with postoperative outcomes available at 30, 90, and 180 days. 5040 patients had data available at 2 years. Serious medical complications like surgical site infection, deep vein thrombosis, acute kidney failure, and sepsis were rare at each point of follow-up. Rates of revision surgery were low at short-term follow-up but were prevalent for both procedures at 2 years (&gt; 2%). The most common orthopaedic complications osteoarthritis, implant/graft failure, and knee instability. However, these incidences remained below 7.5% at each interval. Outcomes were similar for staged and concomitant reconstruction, but osteoarthritis, implant/graft failure, and knee instability were significantly more common in the former group at various points.</p><h3>Conclusions</h3><p>Concomitant ACL and EAL reconstruction demonstrated negligible rates of serious medical complications. While rates of osteoarthritis, instability, and graft failure increased at each point, these were generally comparable to independent ACL and EAL procedures. While there was little difference in outcomes between staged and concomitant reconstruction, the latter should be preferred due to lower rates of osteoarthritis, graft failure, and instability.</p><h3>Level of evidence</h3><p>Level III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06422-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crowe severity and femoral stem geometry are associated with lower-limb alignment after total hip arthroplasty for unilateral developmental dysplasia of the hip–related secondary osteoarthritis: valgus alignment trajectories","authors":"Muhammed Yusuf Afacan,&nbsp;Mahmut Gorkem Gurcinar,&nbsp;Cumhur Deniz Davulcu,&nbsp;Mehmet Can Unlu,&nbsp;Gokhan Kaynak","doi":"10.1007/s00402-026-06462-6","DOIUrl":"10.1007/s00402-026-06462-6","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Total hip arthroplasty (THA) for secondary osteoarthritis related to developmental dysplasia of the hip (DDH) restores hip mechanics. We aimed to quantify pre-to-postoperative changes in ipsilateral knee and global lower-limb alignment after unilateral THA to determine whether alignment changes differ by Crowe classification and femoral stem geometry.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;This retrospective cohort study included 74 patients who underwent unilateral primary THA for DDH-related secondary osteoarthritis, with a mean follow-up of 45.4 months. The predefined primary radiographic outcome set comprised preoperative-to-postoperative changes and final follow-up values in coronal lower-limb alignment parameters, including mechanical and anatomic lateral distal femoral angles (mLDFA and aLDFA), mechanical medial proximal tibial angle (mMPTA), joint line convergence angle (JLCA), global offset (GO), hip–knee–ankle angle (HKA), knee mechanical axis deviation ratio (KMADR), and femoral mechanical–anatomic axis angle (FMMA). The contralateral reference limb was used for side-to-side radiographic comparison. Patients were stratified by Crowe classification (I–II vs. III–IV), and femoral stem geometry analyses were performed according to conical, wedge, and rectangular stem designs. Clinical outcomes included hip/knee visual analog scale, Harris Hip Score, Knee Society Score, Oxford Knee Score, KOOS, and WOMAC.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Analysis of the predefined radiographic outcome set demonstrated divergent alignment profiles according to Crowe severity. In Crowe I–II, several preoperative-to-postoperative changes were nominally observed, but these did not remain statistically significant after FDR adjustment; postoperative side-to-side differences largely converged toward the contralateral reference limb. In Crowe III–IV, a more robust valgus-oriented postoperative profile was observed, with FDR-significant changes in mLDFA, aLDFA, mMPTA, JLCA, GO, HKA, and FMMA, and persistent postoperative asymmetry versus the contralateral reference limb for most parameters except GO. Between Crowe groups, postoperative HKA was significantly higher and FMMA significantly lower in Crowe III–IV after multiplicity adjustment, whereas mMPTA and KMADR showed nominal between-group differences. In exploratory stem-geometry analyses, postoperative between-group differences in mLDFA and FMMA remained significant after FDR adjustment, whereas aLDFA and HKA showed nominal differences only. Clinical outcomes improved substantially in both Crowe strata, and clinical scores were comparable across femoral stem geometry groups.&lt;/p&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;In unilateral DDH-related osteoarthritis treated with THA, postoperative lower-limb alignment changes were associated with Crowe severity and showed only partial normalization relative to the contralateral reference limb. High-grade DDH demonstrated a more valgus-oriented postoperative radiographic profile, whereas ","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06462-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of distal screw number on axial deformation and fragment-specific stability in AO/OTA 2R3 C2.1 distal radius fractures","authors":"Lena Dietz,&nbsp;Christian Spiegel,&nbsp;Felix Christian Kohler,&nbsp;Uta Biedermann,&nbsp;Ivan Zderic,&nbsp;Alicia Feist,&nbsp;Boyko Gueorguiev-Rüegg,&nbsp;Mark Lenz,&nbsp;Wolfram Weschenfelder","doi":"10.1007/s00402-026-06454-6","DOIUrl":"10.1007/s00402-026-06454-6","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate the biomechanical influence of distal screw number in palmar plate fixation of unstable intra-articular distal radius fractures with radiodorsal metaphyseal comminution.</p><h3>Methods</h3><p>Nine matched pairs of cryopreserved human radii were prepared using a standardized AO/OTA 2R3 C2.1 fracture model with a defined radiodorsal metaphyseal defect zone. For each pair, specimens were randomized to palmar fixation using a 2.4-mm variable-angle locking plate with either four or six distal screws. After embedding, constructs were subjected to cyclic axial loading (150 N, 5,000 cycles) simulating early postoperative rehabilitation. Global axial deformation and fragment-specific three-dimensional interfragmentary motion were recorded using an optical motion-tracking system. Statistical analysis was performed using non-parametric tests (<i>p</i> &lt; 0.05).</p><h3>Results</h3><p>Two specimens from one donor pair were excluded, leaving 16 radii (8 pairs) for analysis. Bone mineral density and initial construct stiffness did not differ between groups. The six-screw configuration showed significantly lower axial deformation after cyclic loading (<i>p</i> = 0.047) and lower radial fragment–shaft translation at both time points (<i>p</i> = 0.028; <i>p</i> = 0.045). Radial fragment–shaft rotation was lower in the six-screw group at baseline (<i>p</i> = 0.018), but no rotational difference remained after cyclic loading. In the overall cohort, axial deformation decreased after cyclic loading (<i>p</i> = 0.015).</p><h3>Conclusion</h3><p>In this unstable intra-articular fracture model with radiodorsal metaphyseal comminution, six distal screws reduced post-cyclic axial deformation and radial fragment–shaft micromotion compared with four screws. The clinical relevance of these findings remains to be determined.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06454-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recovery of gait after ankle fracture surgery following early mobilization and weight-bearing","authors":"Leandra Bauer,&nbsp;Anne Sophie Schlegel,&nbsp;Anne Scheuer,&nbsp;Wolfgang Böcker,&nbsp;Hans Polzer,&nbsp;Sebastian Felix Baumbach","doi":"10.1007/s00402-026-06472-4","DOIUrl":"10.1007/s00402-026-06472-4","url":null,"abstract":"<div><h3>Background</h3><p>Ankle fractures are among the most common fractures in adults. Despite significant advancements in surgical techniques, the postoperative treatment regimens remain conservative. This study aims to objectively evaluate gait recovery following early mobilization and weight-bearing after surgical ankle fracture treatment using instrumented gait analysis.</p><h3>Methods</h3><p>This prospective, single-armed, longitudinal study enrolled adult patients following surgical treatment for isolated ankle fractures with early pain dependent weightbearing. Gait analysis, utilizing a treadmill integrated with a pressure plate and IMU-based motion capture systems, was conducted at 6 weeks, 3-, 6-, and 12-months post-surgery, assessing spatio-temporal and kinematic parameters. Results were compared longitudinally and against a healthy control group.</p><h3>Results</h3><p>Longitudinal data were available for 44 patients. Significant (<i>p</i>&lt;.001) improvements of self-paced walking velocity (SPV) were observed from 6 weeks (2.2 ± 1.1 km/h), to 3 (2.9 ± 0.9 km/h) and 6 months (3.4 ± 0.9 km/h). The spatio-temporal parameters showed significant changes between 6 weeks and all further time points only at SPV. Kinematic parameters showed significant longitudinal improvements at SPV for hip, knee, and ankle motion (including all three ankle planes). Patient gait parameters at 6 and 12 months were comparable to healthy controls, except for persistent limitations in ankle sagittal kinematics.</p><h3>Conclusion</h3><p>Patients undergoing surgical ankle fracture repair with early mobilization and full weight-bearing showed substantial gait recovery within 6 weeks. By 12 weeks, patient gait closely resembled healthy controls, highlighting the efficacy of a pain-adapted postoperative regimen for rapid functional recovery and return to previous activity levels.</p><h3>Level of evidence</h3><p>Level II.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06472-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of three knee arthrodesis techniques to manage failed total knee arthroplasty due to infection: intramedullary nailing, LRS external fixator, and compression plating","authors":"Raja Bhaskara Rajasekaran,&nbsp;Hariharan Subbiah Ponniah,&nbsp;Dhanasekara Raja Palanisami,&nbsp;Velmurugesan Purnaganapathi Sundaram,&nbsp;Sivakumar Singanallur Palanivelayutham,&nbsp;Dheenadhayalan Jayaramaraju,&nbsp;Soundarrajan Dhanasekaran,&nbsp;Shanmuganathan Rajasekaran","doi":"10.1007/s00402-026-06469-z","DOIUrl":"10.1007/s00402-026-06469-z","url":null,"abstract":"<div><h3>Introduction</h3><p>This study compared external fixation (EF), intramedullary nailing (IMN), and compression plating (CP) for knee arthrodesis (KA) following failed total knee arthroplasty (TKA) due to periprosthetic joint infection, focusing on complications, radiological, and functional outcomes.</p><h3>Methods</h3><p>Patients aged ≥ 18 who underwent knee arthrodesis following failed TKA due to infection from 2008 to 2023 were included. Four surgeons used three techniques: EF, IMN, and CP. Retrospective data on demographics, surgical techniques, complications, and outcomes were collected. Postoperative patient-reported outcome measures (PROMs), pain, and functional status were assessed. Radiographic data was reviewed for limb shortening and union status.</p><h3>Results</h3><p>46 patients (mean age 61.9 years, BMI 28.2), predominantly male (84.8%) were involved in this study. Twenty patients underwent EF, 16 underwent CP, and 10 underwent IMN, all for infected primary TKA. Pseudomonas was the most common infecting organism (15.2%). Average follow-up was 29.1 months. Bony fusion was achieved in 41 knees (89.1%), with five requiring additional surgery; four eventually required amputation due to non-fusion. EF group had the shortest time to union and no major complications or amputations. Time to union was significantly shorter in the CP group compared to the IMN group (<i>p</i> &lt; 0.001), and EF group also had a significantly shorter time to union compared to IMN (<i>p</i> = 0.02). Infection eradication was 100% in the EF group, with significantly fewer additional surgeries and complications compared to the IMN group. Overall patient satisfaction was high (82.6%), with most patients reporting no pain and functional outcomes ranging from mild limitation to fully normal function.</p><h3>Conclusion</h3><p>KA has shown to be an effective method to control infection, achieve fusion and provide pain relief following failed infected TKA. EF emerged as the preferable method for knee arthrodesis, showing fewer complications, shorter union times, and no additional surgeries compared to IMN and CP.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of iliac crest reference pin placement in total hip arthroplasty: a CT-based analysis of risk factors for cortical perforation","authors":"Yasutaka Masada,&nbsp;Tomonori Tetsunaga,&nbsp;Kazuki Yamada,&nbsp;Tomohiro Inoue,&nbsp;Ryuichiro Okuda,&nbsp;Tomoko Tetsunaga,&nbsp;Yuki Okazaki,&nbsp;Toshifumi Ozaki","doi":"10.1007/s00402-026-06464-4","DOIUrl":"10.1007/s00402-026-06464-4","url":null,"abstract":"<div><h3>Introduction</h3><p>Accurate iliac crest reference pin placement is essential for safe navigation-assisted total hip arthroplasty (THA). Although complications are uncommon, inaccurate placement may cause neurovascular injury. This study aimed to evaluate pin insertion accuracy using postoperative computed tomography (CT), identify risk factors for cortical perforation, and determine whether CT-detected cortical perforation was associated with postoperative acetabular cup positioning accuracy.</p><h3>Materials and methods</h3><p>We retrospectively analyzed 200 primary THAs performed using portable or CT-based navigation between December 2022 and July 2025. Pin position was assessed on CT 1 week postoperatively and classified as complete intraosseous insertion or cortical perforation. Risk factors were examined using univariable and multivariable logistic regression analyses. Perforation direction was evaluated using Firth’s penalized logistic regression. Postoperative cup positioning accuracy was assessed using CT-based radiographic inclination (RI), radiographic anteversion (RA), and absolute errors from target angles of 40° for RI and 15° for RA.</p><h3>Results</h3><p>Cortical perforation occurred in 70 of 200 hips (35.0%): 32 medial and 38 lateral. On a pin-by-pin basis, 113 of 400 pins (28.3%) demonstrated perforation. In multivariable analysis, smaller ASIS width, lateral decubitus positioning, and 4-mm pin use independently predicted cortical perforation. Medial perforation was independently associated with lateral decubitus positioning, 4-mm pin use, and smaller iliac wing angle in Firth’s model. RI, RA, absolute RI error, and absolute RA error did not differ significantly between the intraosseous and cortical perforation groups. All hips in both groups were within 10° of the target angles for both RI and RA. No dislocation or revision surgery occurred in either group.</p><h3>Conclusions</h3><p>CT-detected cortical perforation of iliac crest reference pins was common but was rarely accompanied by clinically apparent complications and was not associated with inferior postoperative cup positioning accuracy. Perforation risk was influenced by insertion position, platform-associated instrumentation, and pelvic morphology. These findings should be interpreted primarily as a technical accuracy endpoint rather than as evidence of clinically proven harm. The clinical significance of CT-detected cortical perforation remains uncertain, and particular attention should be paid to minimizing medial cortical breach.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isometric points in cerclage for patellar tendon repair: a 3-dimensional, weightbearing computed tomography kinematic simulation","authors":"Christoph Zindel,&nbsp;Sandro Hodel,&nbsp;Yichao Luo,&nbsp;Michel Meisterhans,&nbsp;Sandro F. Fucentese,&nbsp;Lazaros Vlachopoulos","doi":"10.1007/s00402-026-06441-x","DOIUrl":"10.1007/s00402-026-06441-x","url":null,"abstract":"<div><h3>Purpose</h3><p>The gold standard for the management of ruptured patellar tendon is the surgical repair with nonabsorbable sutures and additional reinforcement e.g. cerclage wires as described by McLaughlin in 1947. Despite the early description, the exact placement of such cerclage wires remains unclear. The aim of the study was (1) to analyze how the cerclage elongates during knee flexion and (2) to define the insertion points with the most isometric behavior at the patella and tibial tuberosity (TT).</p><h3>Methods</h3><p>3D simulations of 10 healthy knees in the range from 0° to 120° of flexion using weightbearing computed tomography scans were generated. 12 insertion points were defined at the patella in equal distances along the lateral and medial border from the proximal to the distal pole. 42 insertion points were defined at the tibial tuberosity (TT) in a 3.0 × 3.0 cm large grid around its center. An automatic string simulation algorithm was used to calculate the length for all possible combinations of the cerclage from 0° to 120° flexion. The most isometric combination of insertion points was found using the isometric score.</p><h3>Results</h3><p>The most isometric insertion at the TT is distally (<i>p</i> &lt; 0.01) and towards the center of the TT (<i>p</i> &lt; 0.01). The most isometric points at the TT is located 61 mm distal to the joint line and 5 mm from the anterior border of the TT in a true lateral view fluoroscopy. The insertion on the patella is insensible, as long as the patella is not bypassed proximally (<i>p</i> &lt; 0.01).</p><h3>Conclusion</h3><p>Elongation of patella tendon augmentation or cerclage can be reduced when choosing a distal and central insertion at the TT, while the insertion on the patella does not affect elongation as long as the patella is not by passed proximally. This might help to reduce excessive stress and prevent cerclage or augmentation failure.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of arthroscopic single-anchor fixation versus microfracture for osteochondral fractures of the knee weight-bearing area in adolescents and young adults","authors":"Wenbo Yang,&nbsp;Qing Pan,&nbsp;Hong Wang,&nbsp;Yizhong Peng,&nbsp;Chunqing Meng,&nbsp;Wei Huang","doi":"10.1007/s00402-026-06396-z","DOIUrl":"10.1007/s00402-026-06396-z","url":null,"abstract":"<div><h3>Purpose</h3><p>Osteochondral fractures involving the weight-bearing area of the knee in young patients require stable restoration of the native osteochondral fragment whenever possible. This study aimed to evaluate the long-term clinical and radiological outcomes of arthroscopic single-anchor fixation and to compare them with those of microfracture.</p><h3>Methods</h3><p>This retrospective comparative study included 24 adolescents and young adults with osteochondral fractures of the femoral condyle or trochlear region treated between 2016 and 2017. Twelve patients underwent arthroscopic single-anchor in situ fixation, and 12 underwent microfracture. The fixation technique used one double-loaded suture anchor to obtain multi-point compression of the osteochondral fragment while preserving the subchondral plate. Clinical outcomes were assessed using the Lysholm, International Knee Documentation Committee, and Tegner scores. Magnetic resonance imaging was evaluated using the MOCART 2.0 score. The mean follow-up was 93.7 months.</p><h3>Results</h3><p>The single-anchor group showed a significantly higher intraoperative contact area ratio than the microfracture group (96.5% ± 3.2% vs. 85.8% ± 5.6%, <i>P</i> &lt; 0.001). At final follow-up, the single-anchor group had superior Lysholm scores (91 ± 5 vs. 83 ± 8, <i>P</i> = 0.009), IKDC scores (86 ± 6 vs. 78 ± 7, <i>P</i> = 0.010), and Tegner activity levels (5.0 ± 1.1 vs. 3.9 ± 0.9, <i>P</i> = 0.012). MRI evaluation also favored single-anchor fixation, with higher MOCART 2.0 scores at 12 months (82.3 ± 6.4 vs. 61.7 ± 8.1, <i>P</i> &lt; 0.001) and at final follow-up (79.4 ± 7.0 vs. 57.9 ± 9.0, <i>P</i> &lt; 0.001). No fixation failure or revision occurred in the single-anchor group, whereas two patients in the microfracture group required reoperation.</p><h3>Conclusion</h3><p>Arthroscopic single-anchor in situ fixation provided durable clinical improvement and superior long-term MRI repair quality compared with microfracture in adolescents and young adults with osteochondral fractures of the knee weight-bearing area. By preserving the native osteochondral fragment and minimizing subchondral disruption, this technique may represent a useful joint-preserving option for selected young patients with reducible osteochondral fragments.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}