Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Wedge fragments: no significant impact on bone healing in femoral shaft fractures treated with intramedullary nailing.","authors":"Yong-Cheol Yoon, Myung Jin Jang, Jigang Jeun, Hyung Keun Song","doi":"10.1007/s00402-025-06020-6","DOIUrl":"https://doi.org/10.1007/s00402-025-06020-6","url":null,"abstract":"<p><strong>Introduction: </strong>Intramedullary nailing (IMN) is the treatment of choice for femoral shaft fractures with wedge-shaped fragments. However, the management of wedged fragments remains controversial. This study investigated whether wedged fragments affect bone union rates in patients treated with IMN. The primary hypothesis was that wedged fragments would not significantly affect bone union when proper IMN principles were followed.</p><p><strong>Materials and methods: </strong>Between March 2014 and June 2023, 162 patients were diagnosed with femoral shaft fractures (AO/OTA 32-B type) accompanied by wedge fractures. The surgeries involved the use of a reconstruction antegrade nail with a greater trochanteric entry point. Closed reduction was performed, and recon-type screws were used for proximal fixation of the femoral neck and head and at least two screws distally. The wedged fragments were not manipulated further. We analyzed the characteristics of the wedged fragments, including size, displacement, angle, and reversal morphology, and assessed the main fracture gap size in relation to bone union outcomes.</p><p><strong>Results: </strong>The study included 95 of the 162 patients, of whom 82 (86.3%) achieved bone union and 13 (13.7%) experienced nonunion. Demographic and preoperative variables showed no significant differences between the union and nonunion groups. Postoperative radiographic analysis of the wedged fragments revealed no significant differences in fragment size, angle, displacement, or presence of reversed fragments. However, the main fracture gap size significantly differed, averaging 5.2 mm in the union group and 15.6 mm in the nonunion group(p = 0.01). Complications included superficial infections in four patients and malrotation in three, which were managed conservatively.</p><p><strong>Conclusions: </strong>Wedge fragments in femoral shaft fractures do not significantly affect bone union with IMN. Instead, the size of the main fracture gap is critical for healing. Surgery should focus on stable fixation and minimization of the main fracture gap rather than manipulating the wedged fragments.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"401"},"PeriodicalIF":2.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screwless minimally invasive triplane osteotomy for the surgical treatment of hallux valgus in patients aged 60 years and older: a prospective observational clinical study.","authors":"Wahid Rezaie, Sigrid Fauconnier, Sebastian Faict","doi":"10.1007/s00402-025-06017-1","DOIUrl":"10.1007/s00402-025-06017-1","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive surgery (MIS) for hallux valgus gained increasing recognition with comparable clinical and radiological outcomes to traditional open surgery. However, there is lack of evidence for safety and efficacy of MIS in the elderly. The aim of this study is to evaluate the surgical and functional outcomes of hallux valgus correction in elderly using screwless MIS technique according to the \"triplane osteotomy\".</p><p><strong>Materials and methods: </strong>From May 2019 until September 2020 a prospective observational study was set up with patients ≥60 years with symptomatic hallux valgus with an angle (HVA) above 25 degrees or intermetatarsal angle (IMA) above 14 degrees with failure of conservative treatment for at least six months. A single surgeon used a \"triplane osteotomy\" for the metatarsal, an Akin osteotomy and lateral soft tissue release. A temporary K-wire was used and removed after three weeks. Patients were assessed six weeks, three months and one year postoperatively. Clinical and functional assessment were obtained by the visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) and the Foot Function Index (FFI). Radiographical assessment included the HVA, IMA and DMAA.</p><p><strong>Results: </strong>37 patients with a mean of 66.05 ± 5.53 years were included. Preoperatively the VAS reduced from 5.19 ± 2.55 to 0.47 ± 0.99, the FFI from 54.00 ± 13.71 to 26.22 ± 7.81, the AOFAS improved from 46.11 ± 13.41 to 83.46 ± 15.91, the HVA from 34.43 ± 8.38 degrees to 7.31 ± 5.55 degrees, the IMA from 13.58 ± 2.55 degrees to 7.48 ± 2.99 degrees and the DMAA from 11.92 ± 5.43 degrees to 7.52 ± 5.19 degrees at one year follow-up. Except for the FFI at six weeks, all functional outcome scores improved significantly compared to preoperatively (P <.001).</p><p><strong>Conclusions: </strong>Screwless minimally invasive triplane osteotomy provided significant clinical, functional and radiological improvement for the treatment of hallux valgus in patients aged 60 years and older.</p><p><strong>Level of evidence: </strong>Level IV, a prospective observational cohort study.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"398"},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic wrist arthroscopy: findings in patients suspected of TFCC lesions.","authors":"Lyse van Wijk, Sandesh Kasie, Claire Koeyvoets, Sebastiaan Souer, Steven Hovius, Brigitte van der Heijden","doi":"10.1007/s00402-025-06002-8","DOIUrl":"10.1007/s00402-025-06002-8","url":null,"abstract":"<p><strong>Introduction: </strong>Ulnar-sided wrist pain remains a diagnostic challenge due to its complex anatomy and broad differential diagnosis. This study evaluated the diagnostic role and therapeutic consequences of wrist arthroscopy in patients with ulnar-sided wrist pain and suspected triangular fibrocartilage complex (TFCC) lesions.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted on patients undergoing diagnostic wrist arthroscopy for suspected TFCC lesions based on clinical and imaging assessments between 2012 and 2021. Data on the indication, arthroscopic findings, treatment, and complications were collected.</p><p><strong>Results: </strong>500 patients were included with a median age of 38 years (IQR 28.0-49.0), of whom 65.0% were women. The median symptom duration was 8 months (IQR 5.0-16.5), with 61.4% reporting wrist trauma. TFCC lesions were confirmed in 73.6% of cases, most commonly Palmer type 1B and 2C. Additional findings, such as scapholunate or lunotriquetral injuries and cartilage damage, were identified in 31.6% of patients, while 16.0% showed no arthroscopic abnormalities. Based on arthroscopic findings, 46.4% underwent immediate arthroscopic intervention, including TFCC debridement (174, 34.8%), synovectomy (170, 34.0%), or ganglion removal (4, 0.8%). 51.0% proceeded to open surgery within a year, most often TFCC repair or ulnar shortening. Complications occurred in 7.4% of patients, mostly mild.</p><p><strong>Conclusions: </strong>These results highlight wrist arthroscopy as a decisive tool in the diagnostic workup of patients with suspected TFCC lesions, providing valuable information to confirm, classify, or exclude pathology, and to identify concomitant wrist abnormalities. Both positive and negative arthroscopic findings are important for treatment decisions, providing essential guidance for surgical and non-surgical management of ulnar-sided wrist pain.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"399"},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788146","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":"Posttraumatic stenosing tendovaginitis of the fourth extensor tendon compartment: a case report.","authors":"Maximilian Mayrhofer-Schmid, Leila Harhaus, Amr Eisa","doi":"10.1007/s00402-025-06015-3","DOIUrl":"10.1007/s00402-025-06015-3","url":null,"abstract":"<p><strong>Introduction: </strong>While stenosing tendovaginitis of the first extensor tendon compartment is frequently encountered in hand surgical practice, similar pathologies in other extensor tendon compartments are rare and can, thus, be overlooked or misdiagnosed. This case report aims to point out the relevance and intricacies of these pathologies.</p><p><strong>Case: </strong>This report presents a case of posttraumatic stenosing tendovaginitis of the fourth extensor tendon compartment, developed five months after suffering a crush injury to his index finger with simultaneous stump trauma to the dorsal wrist. The patient's main symptoms were a progressive, painful swelling of the dorsal wrist combined with the inability of simultaneous wrist and finger extension and impaired wrist extension while forming a fist. While initial diagnostics, including an MRI, pointed towards a partial extensor tendon injury, the intraoperative findings demonstrated a stenosing tendovaginitis of the fourth extensor tendon compartment. This was treated with synovectomy and Z-plasty of the extensor retinaculum. Twelve weeks postoperatively, the patient had returned to work and was free of pain. A 45° dorsal extension was possible with the fingers forming a fist; with extended fingers, 10° of the wrist extension was possible.</p><p><strong>Conclusions: </strong>This case highlights a rare pathology and underscores the critical importance of thorough intraoperative diagnostics, particularly the assessments of mobility, to correctly identify underlying pathologies and adjust the surgical approach accordingly.</p><p><strong>Level of evidence: </strong>IV Case Report.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"397"},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral malrotation after trochanteric fracture nailing: what is the safety zone of limb rotation during closed reduction?","authors":"Jakub Maléř, Michal Buk, Martin Michna, Milan Hrazdíra, Radek Bartoška, Jiří Skála-Rosenbaum","doi":"10.1007/s00402-025-06019-z","DOIUrl":"10.1007/s00402-025-06019-z","url":null,"abstract":"<p><strong>Introduction: </strong>Improper closed trochanteric fracture reduction can cause rotational malposition which can lead to serious consequences. The primary objective of this study was to assess the hypothetical threshold at which excessive rotation becomes hazardous due to a significant postoperative malrotation.</p><p><strong>Materials and methods: </strong>We conducted a prospective study focused on closed reduction in intramedullary nailing of trochanteric fractures (AO 31A1-3) in 100 consecutive patients and its influence on final malrotation. Immediately after the closed reduction, the rotation of affected limb was measured using a balanced goniometer and the values were compared to the postoperative CT calculation. Final femoral malrotation exceeding 15° was considered significant. All results were statistically analyzed.</p><p><strong>Results: </strong>In total we observed femoral malrotation exceeding 15° in 33 patients (33.3%). Internal rotation was significantly more common than external rotation (31 vs. 2 patients). Intraoperative rotation up to 15° resulted in a malrotation of 10.3% (3/29 patients). When limb rotation on the traction table exceeded 20°, malrotation incidence increased to 51.0% (26/51 patients), making this fixed position a risk factor for significant femoral malrotation (p = 0.0076). General anesthesia was also associated with a significantly higher rate of malrotation compared to spinal anesthesia (p = 0.0154), however we did not find any statistical difference in error rates based on patient BMI or physiological femoral neck ante-version.</p><p><strong>Conclusions: </strong>Our findings underscore the significant risk of femoral malrotation associated with perioperative rotations beyond 20°, emphasizing the need for precise rotational control during surgery. Excessive rotation on the traction table in an attempt to achieve better fracture alignment significantly increases the risk of femoral malrotation.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"395"},"PeriodicalIF":2.1,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783353","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":"Balanced flexion gap is more strongly associated with postoperative outcomes than femoral component rotation in total knee arthroplasty.","authors":"Yun Seong Choi, Jisu Park, Tae Woo Kim, Jae Hee Lee, Moon Jong Chang","doi":"10.1007/s00402-025-06009-1","DOIUrl":"https://doi.org/10.1007/s00402-025-06009-1","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluated (1) the degree of femoral component rotation required to achieve a balanced flexion gap in total knee arthroplasty (TKA) using the extension-first technique, (2) the proportion of patients who achieved balanced flexion and extension gaps, and (3) whether femoral component rotation or gap balance was more closely associated with postoperative outcomes.</p><p><strong>Materials and methods: </strong>A total of 169 patients who underwent total knee arthroplasty using the extension-first technique were retrospectively reviewed. Femoral component rotation was determined based on the posterior condylar line and adjusted to the angle required to attain a balanced flexion gap at 90°. Based on the degree of femoral component rotation (FCR) relative to anatomical landmarks, patients were classified into within-range (WR, between the clinical and surgical transepicondylar axes), internal rotation (IR, FCR less than sTEA), and external rotation (ER, FCR greater than cTEA) groups. The proportions of patients categorized as WR, IR, and ER were assessed, and within each group, the proportion of patients demonstrating balanced mediolateral laxity and symmetric flexion-extension gaps was evaluated. At 2 years postoperatively, the WOMAC score, range of motion, and patellar tilt angle were analyzed and compared between groups categorized by gap balance and femoral component rotation.</p><p><strong>Results: </strong>The proportions of patients classified as within-range (WR), internal rotation (IR), and external rotation (ER) were 51%, 11%, and 38%, respectively. A total of 68% of patients (n = 115) achieved balanced gaps in extension, flexion, and between both, whereas 32% (n = 54) failed to achieve a balanced gap in at least one of these assessments. Among these variables, unbalanced mediolateral laxity in flexion showed a stronger association with worse 2-year postoperative WOMAC scores than femoral component IR or ER, with regression coefficients of 4.993, 2.303, and 2.682 (P = 0.014, 0.274, and 0.152), respectively.</p><p><strong>Conclusions: </strong>Achieving a balanced flexion gap may have greater clinical significance than positioning the femoral component within the range between the clinical and surgical transepicondylar axes (cTEA and sTEA).</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"396"},"PeriodicalIF":2.1,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel mathematical model for preoperatively predicting pelvic tilt in patients with thoracolumbar kyphosis due to ankylosing spondylitis after three-column osteotomy.","authors":"Wen Yin, Guohui Zheng, Wei Zhang, Yunlei Zhai, Kangkang Wang, Xilong Cui, Haiyang Yu","doi":"10.1007/s00402-025-06011-7","DOIUrl":"10.1007/s00402-025-06011-7","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to introduce a novel mathematical model for preoperative precalculated pelvic tilt (PT) in patients with thoracolumbar kyphosis due to ankylosing spondylitis (AS) after three-column osteotomy.</p><p><strong>Methods: </strong>A total of 20 patients with AS, including 19 men and one woman, who underwent three-column osteotomy from April 2017 to April 2021, in the study hospital were retrospectively reviewed. Spinopelvic parameters, including global kyphosis, pelvic incidence, sacral slope, PT, sagittal vertical axis, horizontal distance between hip axis and hilus pulmonis (HDHH), measured on preoperative, postoperative, and final follow-up radiographs were analyzed. A coordinate diagram was created on the lateral spine radiographs with the hip axis as the origin. The distances and angles between the osteotomy apex, hilus pulmonis, and hip axis were measured, and a mathematical model was established using basic vector functions. The planned osteotomy angle was substituted into the mathematical model to obtain precalculated postoperative PT. Paired sample t-test was performed to determine the differences between planned osteotomy angle and actual osteotomy angle and between predictive postoperative PT and actual postoperative PT.</p><p><strong>Results: </strong>Seven patients underwent single-level osteotomy, and 13 patients underwent two-level osteotomy. No significant difference was observed between the planned osteotomy angle and the actual osteotomy angle. No statistically significant difference was found between the precalculated postoperative PT and the actual postoperative PT.</p><p><strong>Conclusions: </strong>The novel mathematical model was reliable in predicting postoperative PT in patients with AS undergoing three-column osteotomy.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"394"},"PeriodicalIF":2.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752153","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 humeral lengthening on post-operative pain scores by three-dimensional measurements in patients undergoing reverse shoulder arthroplasty.","authors":"Katsumasa Nakazawa, Tomoya Manaka, Yukihide Minoda, Yoshihiro Hirakawa, Yoichi Ito, Hayato Shimizu, Ryosuke Iio, Rei Nishiura, Hidetomi Terai","doi":"10.1007/s00402-025-05981-y","DOIUrl":"https://doi.org/10.1007/s00402-025-05981-y","url":null,"abstract":"<p><strong>Purpose: </strong>Humeral lengthening (HL) has been reported to correlate with post-operative clinical outcomes of reverse shoulder arthroplasty (RSA). However, these are simple radiographic evaluations, and three-dimensional (3D) assessments using computed tomography (CT) images have not been considered. This study aimed to investigate the factors that influence post-operative clinical outcomes of RSA implant placement using a 3D evaluation system, specifically, the effect of HL on post-operative clinical outcomes.</p><p><strong>Methods: </strong>This retrospective study included 49 patients who underwent RSA using the Exactech Equinoxe Reverse Shoulder System (Exactech Inc., Gainesville, FL, USA) for cuff tear arthropathy or irreparable rotator cuff tear between August 2017 and June 2021 and were followed up for at least two years post-operatively. An augmented baseplate was used in 19 patients. Pre- and post-operative CT images were used to evaluate post-operative implant placement using the 3D planning software ZedShoulder software (Lexi, Tokyo, Japan). Global offset, overhang of glenosphere, glenoid version, glenoid inclination, HL, and amount of humeral resection were measured. Clinical outcomes were also evaluated in relation to post-operative implant placement.</p><p><strong>Results: </strong>Univariate analysis revealed that HL correlated with the pain score of Constant-Murley score and visual analog scale (VAS) (r=-0.37, p = 0.01; r = 0.38, p = 0.01). Moreover, the overhang of the glenosphere correlated with the Constant-Murley score and the pain score of the Constant-Murley score (r=-0.34, p = 0.02; r = 0.31, p = 0.03). Using multivariate analysis, HL and the overhang of the glenosphere were factors influencing the pain score on the Constant-Murley score (R² = 0.502). Allocating patients with HL into two groups based on the amount of lengthening (≤ 18 mm and > 18 mm), the pain score of the Constant-Murley score and pain VAS were significantly lower in the group with HL of ≤ 18 mm (p < 0.01, p < 0.01).</p><p><strong>Conclusion: </strong>HL affected post-operative pain scores in patients undergoing RSA. Particularly, the group with HL of ≤ 18 mm had a significantly lower pain score. Therefore, we suggest that post-operative pain scores could be improved by reducing the HL to ≤ 18 mm. However, this was a retrospective study with a small number of cases, and the correlation between HL and outcomes requires further investigation.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"391"},"PeriodicalIF":2.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perfectionism leads to burnout and depression among orthopaedic surgeons and residents.","authors":"Mahant Malempati, Bonnie Y Chien, Justin K Greisberg, Nicholas C Danford","doi":"10.1007/s00402-025-06013-5","DOIUrl":"10.1007/s00402-025-06013-5","url":null,"abstract":"<p><strong>Introduction: </strong>Perfection can be a goal within orthopaedic surgery, but it can be associated with depression and/or burnout. The purpose of this study was to determine if there was an association between being a perfectionist and depression and/or burnout among orthopaedic surgeons.</p><p><strong>Methods: </strong>We performed a multi-institutional survey study of orthopaedic surgery residents and faculty. The survey collected demographic data and levels of perfectionism as measured by the validated Positive and Negative Perfectionism Scale (PANPS). The PANPS divides perfection into two types: positive, associated with feelings of pride in one's work, a sense of accomplishment, respect from peers, and a desire to explore the limits of knowledge; and negative, associated with unattainably high expectations, excessive and unnecessary criticism of self and others, and self-doubt. Depression and burnout levels were measured using the validated Patient Health Questionnaire-9 (PHQ-9) and Burnout Assessment Tool (BAT).</p><p><strong>Results: </strong>There were 76 respondents (11 residents and 65 attending physicians) of whom 64 (84.2%) were male and 12 (15.8%) were female. Of these respondents, 18 (23.7%) met the threshold for clinical burnout, and 25 (32.9%) met the threshold for mild depression. Having children was protective against negative aspects of perfectionism (OR 0.30; 95% CI 0.09-1.0; p = 0.049) and was associated with decreased levels of burnout (OR 0.27; 95% CI 0.08-0.91; p = 0.034). Being a perfectionist was associated with higher clinical burnout levels (OR 5.0; 95% CI 1.5-16.9; p = 0.011) and depression (OR 4.0; 95% CI 1.4-11.3; p = 0.009).</p><p><strong>Conclusions: </strong>Negative perfectionist tendencies such as unrealistic self-expectations, excessive self-criticism, and irrational fear of failure are associated with burnout and depression among orthopaedic surgeons. Having children is a protective factor against perfectionism and burnout. These results highlight the importance of understanding perfection within orthopaedic surgery.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"390"},"PeriodicalIF":2.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic evaluation of radial styloid features in de Quervain's tenosynovitis: a case-control study.","authors":"Pormes Suwanno, Naim Hayeebanung, Sitthiphong Suwannaphisit","doi":"10.1007/s00402-025-06012-6","DOIUrl":"10.1007/s00402-025-06012-6","url":null,"abstract":"<p><strong>Purpose: </strong>De Quervain's tenosynovitis (DQV) is a common tendinopathy characterized by inflammation of the first extensor compartment, resulting in pain on the radial side of the wrist. While clinical assessment is primarily utilized for diagnosis, radiographic imaging may be essential for ruling out alternative conditions. This study aimed to investigate specific radiographic measurements of the radial styloid and their correlation with DQV.</p><p><strong>Methods: </strong>We conducted a matched case-control study at a tertiary university hospital in southern Thailand from August 2023 to March 2024, enrolling patients aged 18 years and older who were clinically diagnosed with DQV, characterized by tenderness at the radial styloid and a positive Finkelstein's test. The control group consisted of asymptomatic individuals or those with unrelated wrist pathologies, all of whom had normal radiographic findings. Key radiographic parameters assessed included the radial styloid height ratio, angle of prominence, and the area of the prominent styloid surface, using posteroanterior (PA) wrist radiographs.</p><p><strong>Results: </strong>One hundred participants were analyzed, equally divided into case and control groups. Statistical comparisons indicated no significant differences in the assessed radiographic measurements between groups. The mean radial styloid height ratio was 0.23 ± 0.057 in the case group and 0.232 ± 0.078 in the control group (p = 0.892). The mean angle of radial styloid prominence was 12.6 ± 2.8 degrees in the case group versus 12.9 ± 3.8 degrees in the control group (p = 0.685). Additionally, the mean area of the radial styloid measured 128.3 ± 41.2 square millimeters in the case group compared to 114.5 ± 32.1 square millimeters in the control group (p = 0.099).</p><p><strong>Conclusion: </strong>Although certain parameters showed trends suggesting a potential link between anatomical variations and DQV, none reached statistical significance. Future research should explore additional parameters that may better elucidate the diagnostic value of radiographic imaging in patients with de Quervain's tenosynovitis and inform clinical management strategies.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"392"},"PeriodicalIF":2.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740982","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}