Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Assessing PHILOS plate as an alternative fixation method for pediatric femoral neck fractures: a biomechanical comparison with cannulated screws","authors":"Bo Shiun Lim,&nbsp;Yu-Po Wang,&nbsp;Shang-Ta Chung,&nbsp;Chi-Hsiu Wang,&nbsp;Shu-Wei Chang,&nbsp;Ting-Ming Wang,&nbsp;Chih-Kai Hong","doi":"10.1007/s00402-026-06299-z","DOIUrl":"10.1007/s00402-026-06299-z","url":null,"abstract":"<div><h3>Background</h3><p>Pediatric femoral neck fractures require stable fixation to avoid complications. It remains unclear whether fixation with the Proximal Humeral Internal Locking System (PHILOS) can serve as an alternative to cannulated screw fixation. The purpose of this study was to compare the biomechanical properties of PHILOS and cannulated screws for stabilizing unstable pediatric femoral neck fractures using a synthetic bone model.</p><h3>Materials and methods</h3><p>Twelve fourth-generation synthetic composite femurs were randomly assigned to screw fixation (Group S) or PHILOS fixation (Group P) (<i>n</i> = 6 each). A standardized vertically oriented Delbet type II osteotomy was created in all specimens. Group S was fixed with three 6.5-mm cannulated screws, whereas Group P received a PHILOS plate with 3.5-mm locking screws. Each specimen underwent a standardized loading protocol using a universal testing machine. Axial stiffness, cyclic displacement, ultimate failure load, and failure modes were recorded and statistically compared between groups.</p><h3>Results</h3><p>No statistically significant difference was found in axial stiffness between Group P (746 ± 300 N/mm) and Group S (753 ± 256 N/mm) (<i>p</i> = 1.000). Displacement after cyclic loading was significantly greater in Group P (1.42 ± 0.3 mm) compared with Group S (0.57 ± 0.2 mm) (<i>p</i> = 0.004). The ultimate failure load was higher in Group S (2378 ± 513 N) than it was in Group P (1652 ± 206 N) (<i>p</i> = 0.025). Upon reaching ultimate load, all specimens in both groups failed at the femoral head region due to femoral head broken.</p><h3>Conclusions</h3><p>The adult PHILOS plate with 3.5-mm locking screws demonstrated inferior biomechanical stability compared with three 6.5-mm cannulated screws in this synthetic composite femur model.</p><h3>Level of evidence</h3><p>Controlled laboratory study.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06299-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810133","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":"Male incidence rates outpacing females: results from a nationwide analysis on acetabular fractures in Germany","authors":"Florian Baumann,&nbsp;Susanne Bärtl,&nbsp;Dominik Szymski,&nbsp;Katja Hierl,&nbsp;Volker Alt,&nbsp;Viola Freigang","doi":"10.1007/s00402-026-06332-1","DOIUrl":"10.1007/s00402-026-06332-1","url":null,"abstract":"<div><h3>Introduction</h3><p>Acetabular fractures are uncommon, but serious injuries. Demographic changes may have a significant impact on planning healthcare structures to improve treatment outcomes. Aim of this nationwide, registry-based retrospective controlled study was to identify incidence trends, demographic characteristics, and care structures of patients with acetabular fractures in Germany.</p><h3>Materials and methods</h3><p>We analyzed inpatient data from the Institute for the Hospital Remuneration System (InEK). Based on 52 095 patients with primary diagnosis of an acetabular fracture between 2019 and 2024, we calculated incidence rates for different age-groups and put a spotlight on geriatric acetabular fractures (&gt; 65 years of age).</p><h3>Results</h3><p>Incidence rates in patients under 65 years remained stable, whereas patients over 65 years showed a significant age-dependent increase with an exponential rise in men aged 80 + with the highest incidence being 122.4/100 000 inhabitants annually. We recorded high levels of co-morbidity and nursing care dependency for elderly patients after acetabular fracture. Although 43% of patients were treated in hospitals &gt; 500 beds, acetabular fractures were managed across all hospital sizes.</p><h3>Conclusions</h3><p>There is a rapidly increasing incidence of geriatric acetabular fractures, predominantly driven by elderly male patients over 80 years. Patients over 65 years are associated with high rates of co-morbidities and nursing care levels.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06332-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810237","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":"Healthcare utilization following hip fractures based on social vulnerability status in the US: an analysis of 2016–2020 nationwide readmissions data","authors":"Ria Tilve,&nbsp;Guangjin Zhou,&nbsp;Shujaa T. Khan,&nbsp;Siran M. Koroukian,&nbsp;Matthew Deren,&nbsp;Nicolas S. Piuzzi","doi":"10.1007/s00402-026-06322-3","DOIUrl":"10.1007/s00402-026-06322-3","url":null,"abstract":"<div><h3>Introduction</h3><p>Social vulnerability (SV) influences rehabilitation and postoperative care for patients with hip fracture. However, most previous work relies on area-level measures that overlook interindividual variation. The recent adoption of ICD-10 Z-codes allows clinical identification of patient-level SV and may offer a better understanding of its impact. This study aimed to evaluate healthcare utilization, including readmissions, discharge disposition, and length of stay (LOS) in surgically treated hip fracture patients with and without clinically acknowledged SV.</p><h3>Methods</h3><p>Adults surgically treated for hip fracture between 2016 and 2020 were included from the Nationwide Readmissions Database. SV was defined as having at least one documented relevant ICD-10 Z-code. Primary outcome measures included complications, LOS, discharge disposition, and 30- and 90-day readmissions, stratified by SV and evaluated using chi-square analyses. Multivariable logistic regression assessed long LOS (≥ 5 days) and discharge to home, adjusting for age, insurance/income status, and substance use.</p><h3>Results</h3><p>Patients with SV were younger (35.6% with SV vs. 50.1% without SV were 81+), had a lower median household income (38.8% with SV vs. 25.7% without SV were in the lowest quartile), and were more often insured by Medicaid (19.3% vs. 3.8%). Alcohol/drug use disorders were significantly more prevalent in patients with SV (18.5% vs. 4.5%). SV was associated with 47% higher odds for long LOS (1.47, 1.41–1.54) and 23% higher odds for discharge to home (1.23, 1.16–1.30) but comparable 90-day readmissions (21.2% vs. 19.8%).</p><h3>Conclusion</h3><p>Among surgically treated hip fracture patients, SV was associated with higher odds of long LOS and discharge to home but no meaningful difference in readmissions. The small number of patients with clinically documented SV highlights the limited reporting by healthcare workers. This analysis of a nationwide all-payer database highlights the need to identify these higher risk patients and implement appropriate care pathways to reduce healthcare utilization.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06322-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810134","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":"Advancing pelvic and acetabular trauma education","authors":"Roman Pfeifer,&nbsp;Axel Gaensslen,&nbsp;Jan Lindahl,&nbsp;Anders Enocson,&nbsp;Frank Hildebrand,&nbsp;Hans-Christoph Pape","doi":"10.1007/s00402-026-06306-3","DOIUrl":"10.1007/s00402-026-06306-3","url":null,"abstract":"<div>\u0000 \u0000 <p>Pelvic and acetabular injuries are uniquely demanding due to complex three-dimensional anatomy, the proximity of critical neurovascular structures, and the incidence of these fractures in elderly, a well as and polytrauma patients, is increasing. While existing courses focus heavily on acute surgical management and established techniques, they often omit critical subjects such as complication management, revision strategies, and interdisciplinary care. To establish an international benchmark for surgical excellence in pelvic surgery, the proposed program may utilize a competency-based framework divided into three parts: Part 1: Theoretical Foundation: Independent study of biomechanics, pathology, and operative planning, validated by a rigorous multiple-choice examination. Part 2: Surgical Skills Assessment: Evaluation of technical precision and intraoperative decision-making within a controlled wet lab environment. Part 3: Clinical Reasoning &amp; Reflection: Expert-led discussions centered on the participant’s own clinical cases, focusing on evidence-based reasoning and the management of complex revisions. By standardizing these advanced competencies, the program aims to ensure surgeons possess both the technical proficiency and the mature clinical judgment required to deliver high-quality care for complex pelvic and acetabular trauma cases.</p>\u0000 </div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06306-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760602","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":"Antibiotic prophylaxis for open lower extremity fractures: a comparative propensity-scored matched analysis of cefazolin vs. piperacillin-tazobactam","authors":"Kush S. Mody,&nbsp;Anish K. Ponna,&nbsp;Ryan T. Santilli,&nbsp;Andrew Laychur,&nbsp;Joseph Galloway,&nbsp;Mark Adams,&nbsp;Mark Reilly,&nbsp;Sheldon Lin","doi":"10.1007/s00402-026-06333-0","DOIUrl":"10.1007/s00402-026-06333-0","url":null,"abstract":"<div><h3>Introduction</h3><p>Optimal antibiotic prophylaxis for open fractures remains controversial, particularly regarding whether broader-spectrum regimens offer clinical advantages over cefazolin monotherapy. Despite guideline recommendations supporting first-generation cephalosporins for most open fractures, many centers routinely administer piperacillin-tazobactam. This study aims to evaluate differences in postoperative outcomes between cefazolin and piperacillin-tazobactam in lower extremity open fractures across all Gustilo-Anderson types.</p><h3>Materials and methods</h3><p>This retrospective cohort study was performed using the TriNetX database to identify adult patients with Gustilo-Anderson type I-III lower extremity open fractures who received either cefazolin or piperacillin-tazobactam. 1:1 propensity score matching controlled for age, sex, demographics, and relevant comorbidities. Outcomes were assessed at 90 days and 1 year using risk ratios (RR) with corresponding 95% confidence intervals.</p><h3>Results</h3><p>A total of 47,692 patients met inclusion criteria prior to matching. After matching, 1,527 patients remained in each treatment group for the combined type I/II/III cohort and similar matched pairs were obtained for type I/II and type III subgroups. At 90 days, cefazolin was associated with significantly lower rates of surgical site infection (RR 0.569), osteomyelitis (RR 0.292), sepsis (RR 0.244), reoperation (RR 0.474), readmission (RR 0.518), thromboembolic events (RR 0.480), AKI (0.448), and mortality (RR 0.208) across most analyses. Nonunion/malunion rates were similar between groups for type I/II and the combined cohort (<i>p</i> &gt; 0.05), but higher among type III fractures treated with cefazolin (RR1.933). At 1 year, cefazolin was associated with significantly lower reoperation (RR 0.564), implant removal (RR 0.585), and mortality (RR 0.298) across all analyses, with persistently higher nonunion/malunion risk in type III fractures (RR 1.929).</p><h3>Conclusion</h3><p>Cefazolin was associated with comparable or superior outcomes to piperacillin-tazobactam for most postoperative complications following lower extremity open fractures. These findings support current guideline-aligned stewardship practices and question the routine use of broader-spectrum prophylaxis, particularly outside specific contamination scenarios.</p><h3>Level of evidence</h3><p>III – Retrospective Comparative Study.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06333-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760612","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":"Venous thromboembolism prophylaxis in total shoulder arthroplasty: a matched cohort analysis","authors":"Akhil Katakam,&nbsp;Tej Joshi,&nbsp;Thomas Soussou,&nbsp;Francis Sirch,&nbsp;Tuckerman Jones,&nbsp;Teren Yedikian,&nbsp;John Erickson","doi":"10.1007/s00402-026-06291-7","DOIUrl":"10.1007/s00402-026-06291-7","url":null,"abstract":"<div><h3>Background</h3><p>Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially life-threatening complication following total shoulder arthroplasty (TSA). Despite the increased use of chemical prophylaxis, its effectiveness and safety in TSA populations remain unclear. This study evaluated the incidence of VTE, bleeding events, and related outcomes among TSA patients with and without postoperative chemical prophylaxis.</p><h3>Materials and methods</h3><p>A retrospective cohort study was conducted using the TriNetX database, identifying patients who underwent TSA, stratifying into two cohorts: those who received chemical VTE prophylaxis and those who did not. Propensity score matching (1:1) was employed to balance demographics, comorbidities, and other confounding variables. Outcomes, including VTE, bleeding events, prosthetic joint infection (PJI), revision, and mortality, were assessed at 30 days, 90 days, and 6 months postoperatively.</p><h3>Results</h3><p>After matching, 9,859 patients were included in each cohort. There was no significant difference in the incidence of VTE, PE, or DVT at any time point between the groups. Patients who received prophylaxis showed a reduced risk of ischemic stroke at 30 days (HR 0.539; 95% CI 0.367–0.793; <i>p</i> = 0.001) and myocardial infarction (MI) at both 30 days (HR 0.469; 95% CI 0.306–0.718; <i>p</i> &lt; 0.001) and 90 days (HR 0.720; 95% CI 0.519–0.997; <i>p</i> = 0.047). However, at 6 months, patients with prophylaxis demonstrated an increased risk of mortality (HR 1.812; 95% CI 1.003–3.273; <i>p</i> = 0.046).</p><h3>Conclusion</h3><p>Chemical prophylaxis did not reduce the risk of VTE after TSA but was associated with a lower incidence of ischemic stroke and MI in the early postoperative period. The increased long-term mortality risk observed in the prophylaxis group warrants further investigation to optimize VTE prevention strategies for TSA patients.</p><h3>Level of evidence</h3><p>Level III Retrospective Cohort Comparison Using Large Database Prognosis Study.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06291-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760565","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":"Scaphoid waist fractures in the presence of carpal coalitions: a consistent biomechanical weak point?","authors":"Stefanie Schmitt,&nbsp;Dorrit Winterholer,&nbsp;Elmar Fritsche","doi":"10.1007/s00402-026-06300-9","DOIUrl":"10.1007/s00402-026-06300-9","url":null,"abstract":"<div>\u0000 \u0000 <p>Carpal coalitions may alter intercarpal kinematics and load transfer. Reported coalition-associated scaphoid fractures show an exclusive predilection for the scaphoid waist, raising the possibility of a non-random biomechanical mechanism with focal stress concentration. These injuries have been associated with delayed union and nonunion. This pattern may justify CT-based assessment and consideration of a lower threshold for early surgical stabilization, including percutaneous screw fixation even in selected nondisplaced waist fractures. However, the currently available evidence is limited to case reports and does not allow firm treatment recommendations. Awareness of coalition anatomy and careful follow-up may be reasonable.</p>\u0000 </div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760622","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":"Prophylactic percutaneous intra-aortic balloon occlusion reduces blood loss during anterior acetabular fracture surgery: a propensity score-matched study","authors":"Shozo Kanezaki,&nbsp;Masashi Miyazaki,&nbsp;Akihiro Hino,&nbsp;Masahiro Kawagishi,&nbsp;Jun Nishine,&nbsp;Takuto Shigemi,&nbsp;Nobuhiro Kaku","doi":"10.1007/s00402-026-06329-w","DOIUrl":"10.1007/s00402-026-06329-w","url":null,"abstract":"<div><h3>Introduction</h3><p>Intra-aortic balloon occlusion (IABO) is used to control pelvic hemorrhage and has recently been adapted to elective surgery to limit intraoperative blood loss. Its role in acetabular fracture fixation, particularly via anterior approaches, remains unclear. This study evaluated whether prophylactic percutaneous IABO is associated with reduced blood loss during anterior open reduction and internal fixation (ORIF) of acetabular fractures, using propensity score matching (PSM) to minimize selection bias.</p><h3>Materials and methods</h3><p>We conducted a retrospective cohort study including 80 consecutive adult patients who underwent anterior ORIF for acetabular fractures between 2013 and 2024. Twenty-four patients received prophylactic percutaneous IABO, and 56 served as controls. One-to-one PSM (caliper 0.2 SD of the logit) was performed on demographics, fracture characteristics, and surgical factors, yielding 20 matched pairs. Outcomes included intraoperative blood loss (IBL; primary), total blood loss (TBL; gross formula), operative time, transfusion, reduction quality, perioperative complications, and IABO-related parameters.</p><h3>Results</h3><p>IABO was associated with significantly lower blood loss both before and after matching. In matched pairs, median IBL was 525 g versus 1070 g in controls (<i>p</i> = 0.004), representing a 51% reduction, while TBL was 601 g versus 921 g (<i>p</i> = 0.003), corresponding to a 35% reduction. Operative time, reduction quality, infection, and venous thromboembolism did not differ between groups. In the IABO cohort, the median insertion time was 13 min and balloon inflation duration was 43 min. No IABO-related complications were observed in this cohort.</p><h3>Conclusions</h3><p>Prophylactic percutaneous IABO was associated with a significant reduction in intraoperative and total blood loss during anterior acetabular fracture fixation. Given its minimal additional setup time, it may serve as a practical adjunct in selected high-risk anterior approaches. Further prospective studies are warranted to confirm these findings.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760594","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":"Mid- to long-term outcomes and survival of total hip arthroplasty using a Kerboull-type acetabular reinforcement plate: an analysis of associated factors","authors":"Shinnosuke Gosho,&nbsp;Nobuhiro Kaku,&nbsp;Tsuguaki Hosoyama,&nbsp;Yutaro Shibuta,&nbsp;Kensei Tanaka","doi":"10.1007/s00402-026-06327-y","DOIUrl":"10.1007/s00402-026-06327-y","url":null,"abstract":"<div><h3>Introduction</h3><p>: Revision total hip arthroplasty (THA) for acetabular bone loss is challenging. The modified Kerboull-type (KT) plate has been adopted; nonetheless, mid- to long-term clinical outcomes remain poorly understood. We evaluated survival rates and radiographic outcomes of acetabular reconstruction using the KT plate and investigated risk factors for plate breakage or re-revision.</p><h3>Materials and methods</h3><p>We retrospectively included 120 patients (130 hips) who underwent acetabular reconstruction using the KT plate (1997–2024) and evaluated perioperative outcomes, Harris Hip Score (HHS), survival rates, and key radiographic parameters.</p><h3>Results</h3><p>Mean age at surgery and follow-up duration were 69.0 ± 10.4 years and 107.4 ± 71.7 months, respectively. Mean blood loss and operative time were 630.2 mL and 284.3 min, respectively. HHS improved from 56.2 to 86.4. Fractures (5.3%) and dislocations (3.0%) were observed. Ten-year survival rates were 95.6% for re-revision and 93.0% for plate breakage. Failure and head migration occurred in 11 (8.5%) and 6 (4.6%) hips, respectively. Multivariate analysis identified younger age, use of morselized bone chips alone, and postoperative head migration as independent predictors of failure. In revision THA cases with ≥ 5-year follow-up and Paprosky classification type 3 A or 3B defects, age, Knight classification, and head migration differed significantly between hips with and without failure. Hips with plate breakage requiring re-revision showed greater horizontal head migration than those managed nonoperatively.</p><h3>Conclusions</h3><p>KT plate-based acetabular reconstruction achieved excellent mid- to long-term outcomes, with a 10-year survival rate exceeding 95% and significant functional improvement. Younger age, bone chip grafting alone, and femoral head migration were associated with failure. Even when plate breakage occurred, re-revision was avoided if bulk bone grafts provided sufficient mechanical support and head migration remained minimal. Surgical outcomes were better in the later period than in the early period due to improved learning, surgical techniques, and grafting strategies.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760576","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":"Comparison between the accuracy of conventional and portable computed tomography-based navigation systems in total hip arthroplasty","authors":"Hiroshi Asai,&nbsp;Yusuke Osawa,&nbsp;Yasuhiko Takegami,&nbsp;Hiroto Funahashi,&nbsp;Shiro Imagama","doi":"10.1007/s00402-026-06321-4","DOIUrl":"10.1007/s00402-026-06321-4","url":null,"abstract":"<div><h3>Background</h3><p>Although conventional computed tomography (CT)-based navigation provides excellent placement accuracy and clinical outcomes, whether recently introduced portable systems can achieve comparable results remains unclear. This study aimed to evaluate the placement accuracy and surgical outcomes of portable CT-based navigation systems.</p><h3>Methods</h3><p>This study assessed 56 hips of patients that underwent total hip arthroplasty (THA) using portable CT-based navigation. Using propensity score matching based on age, sex, and body mass index, we identified 51 hips treated with portable CT-based navigation (portable CTN group) and 51 hips with conventional CT-based navigation (CTN group). The evaluation parameters included cup orientation accuracy, cup positioning, operative time, blood loss, preoperative and postoperative Japanese Orthopaedic Association scores, and complications.</p><h3>Results</h3><p>Regarding accuracy error, the portable CTN (radiographic inclination [RI]: 2.8 ± 2.8°, radiographic anteversion [RA]: 3.8 ± 3.2°) and CTN groups (RI: 2.7 ± 1.9°, RA: 3.0 ± 2.1°) did not significantly differ. For navigation error, the portable CTN group (RI: 3.2 ± 3.2°, RA: 3.5 ± 3.1°) had significantly inferior results to the CTN group (RI: 2.2 ± 1.7°, RA: 2.3 ± 1.7°) regarding anteversion. The portable CTN group demonstrated a significantly lower accuracy, as the proportion of hips with a navigation error of &gt; 5° was 31.4% (16 hips), compared to 11.8% (6 hips) in the CTN group. For cup position, the horizontal position error in the portable CTN group was 3.1 ± 1.8 mm, significantly less accurate than the 2.3 ± 1.9 mm in the CTN group. No significant differences were observed in the clinical outcomes within the follow-up period of one year.</p><h3>Conclusion</h3><p>Portable CT-based navigation was inferior to conventional CT-based navigation in terms of placement accuracy, including cup orientation and positioning. While clinical outcomes did not significantly differ at the one-year follow-up, this short-term follow-up limits conclusions on long-term clinical equivalence. Future advancements in portable CT-based navigation systems are required to improve their accuracy.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760554","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}