BMC Musculoskeletal Disorders最新文献

{"title":"Correction: Anterior lumbar discectomy and fusion: an effective technique in treating lumbar disc herniation-- a retrospective case study.","authors":"Boyan Zhang, Can Zhang, Yueqi Du, Maoyang Qi, Hongfeng Meng, Tianyu Jin, Jialu Wang, Jian Guan, Wanru Duan, Zan Chen","doi":"10.1186/s12891-025-08516-z","DOIUrl":"https://doi.org/10.1186/s12891-025-08516-z","url":null,"abstract":"","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"350"},"PeriodicalIF":2.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810485","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 minimally invasive carpal tunnel release using a specialized surgical kit: a prospective multi-center case series.","authors":"Hsuan-Fu Chen, Shun-Min Chang, Chih-Ming Kao, Yu-Lin Chen, Li-Ting Kao, Ya-Chuan Hsu, Yin-Chih Fu, Yan-Hsiung Wang, Wen-Chih Liu, Tien-Ching Lee","doi":"10.1186/s12891-025-08612-0","DOIUrl":"https://doi.org/10.1186/s12891-025-08612-0","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel syndrome (CTS) is the most common peripheral nerve compression neuropathy. While established surgical techniques have demonstrated reliable outcomes and safety profiles, innovations in minimally invasive approached continue to emerge. This study evaluates a novel minimally invasive surgical technique using a specialized instrument for carpal tunnel release.</p><p><strong>Methods: </strong>In this prospective multi-center case series, 41 patients underwent minimally invasive carpal tunnel release using a novel surgical kit. Outcomes were assessed through Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), grip and pinch strength measurements, and nerve conduction velocity (NCV) testing at regular intervals over 24 weeks post-surgery.</p><p><strong>Results: </strong>Mean surgical time was 7.02 min. Significant improvements were observed in VAS scores (LS-Mean - 0.57, P < 0.0001) and BCTQ scores (Symptom Severity: LS-Mean - 2.62, P < 0.0001; Functional Status: LS-Mean - 1.20, P < 0.0001) by 24 weeks. Grip and pinch strengths showed significant improvement from 2 weeks post-surgery. Mean time to return to work was 18.2 days. NCV testing demonstrated significant improvements in both latency (LS-Mean - 0.57, P < 0.0001) and velocity (LS-Mean 5.79, P < 0.0001). One superficial infection and two cases of temporary numbness were reported, with no recurrent CTS observed.</p><p><strong>Conclusions: </strong>This novel minimally invasive technique demonstrates promising clinical outcomes with shortened operative time, rapid symptom relief, and early functional recovery. While larger randomized studies are needed, these preliminary findings suggest this technique may be a valuable addition to current surgical options for CTS.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov, NCT05067205. Prospectively registered, date of first registration: 05/10/2021 ( https://clinicaltrials.gov/study/NCT05067205 ).</p>","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"346"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810499","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":"Spinal deformity after thoracotomy in children with pulmonary hydatid disease.","authors":"Şehmuz Kaya, Abdulmutalip Karaaslanlı, Burhan Beger","doi":"10.1186/s12891-025-08584-1","DOIUrl":"https://doi.org/10.1186/s12891-025-08584-1","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hydatid cyst disease is a common zoonotic infection, especially in agricultural and livestock communities. Thoracotomy is an important surgical procedure in the treatment of pulmonary hydatid cysts in children. However, the development of a spinal deformity is one of the long-term musculoskeletal complications of this procedure. The aim of this study was to evaluate the incidence, risk factors and clinical outcomes of spinal deformity in pediatric patients after thoracotomy.</p><p><strong>Methods: </strong>Between 2008 and 2022, 116 pediatric patients who underwent thoracotomy for pulmonary hydatid disease and met the study criteria were retrospectively reviewed. Age, sex, side of surgery, pre- and postoperative spinal radiographs, presence of spinal deformity and Cobb angles were measured.</p><p><strong>Results: </strong>Spinal deformities developed in 57.8% of 116 patients after thoracotomy. The risk of spinal deformity increases with decreasing age at surgery. The side of the thoracotomy can influence the direction of the apex of the spinal deformity. However, sex had no significant effect on the development of spinal deformity.</p><p><strong>Conclusions: </strong>Children with pulmonary hydatid cyst disease are at high risk of developing spinal deformity after thoracotomy, and this risk is greater in younger patients. This study emphasises the importance of multidisciplinary approaches in the prevention and management of spinal deformity.</p>","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"344"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810513","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":"Clinical analysis of Ganz approach in the treatment of Pipkin type IV fracture: a retrospective review.","authors":"Zhiwen Wang, Guy Romeo Kenmegne, Jingjun Zeng, Ming Chen","doi":"10.1186/s12891-025-08583-2","DOIUrl":"https://doi.org/10.1186/s12891-025-08583-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the early clinical outcomes of the Ganz approach in treating Pipkin IV fractures.</p><p><strong>Methods: </strong>From January 2016 to January 2021, 22 patients with Pipkin IV fracture were treated in our department with Ganz approach. The operation time, intraoperative blood loss, fracture healing time, the incidence of postoperative complications such as heterotopic ossification of hip joint and avascular necrosis of femoral head were recorded. Radiological assessment of fracture reduction was achieved using Matta's evaluation criteria. The functional recovery of the hip joint was assessed using the Harris Hip Score at one year and before the current study, as well as the modified Merle d'Aubigné and Postel score during the final evaluation.</p><p><strong>Results: </strong>21 patients were available for follow up. The average intraoperative blood loss was 145.5 ± 39.3 ml and the average operation time was 150.4 ± 40.6 min. The average follow-up time was 39.2 ± 11.2 months. X-ray confirmed bony healing of the femoral head, acetabular fractures, and greater trochanter osteotomy, with an average healing time of 7.22 ± 3 months. The difference between the Harris hip score of hip joint at one year and at the last follow-up was not statistically significant (p = 0.06). At final follow up with the modified Merle D'Aubigne Postel score, nine had excellent functional outcome; ten presented very good to good result while two patients had average (one) to poor (one) result. Two (9.5%) patient developed osteonecrosis (avascular necrosis) of the femoral head.</p><p><strong>Conclusion: </strong>The Ganz approach effectively preserves the blood supply to the femoral head, moreover, it also fully expose the operative fields such as hip joint and femoral head, achieving satisfactory clinical outcomes, making it a valuable option for clinical application.</p>","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"343"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810476","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":"A retrospective study on the efficacy of unilateral biportal endoscopic discectomy treating lumbar disc herniation and concomitant grade I stable degenerative lumbar spondylolisthesis.","authors":"Haozhong Wang, Changming Xiao, Kaiquan Zhang, Mingzhong Xie, Haoping Dai","doi":"10.1186/s12891-025-08595-y","DOIUrl":"https://doi.org/10.1186/s12891-025-08595-y","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to retrospectively assess the clinical and radiographic outcomes of unilateral biportal endoscopic discectomy (UBED) in treating patients with single-level lumbar disc herniation (LDH) and concomitant grade I stable degenerative lumbar spondylolisthesis (DLS).</p><p><strong>Methods: </strong>We reviewed patients diagnosed with single-level LDH and concomitant grade I stable DLS who underwent UBED from June 2021 to June 2023. Preoperative and postoperative slippage percentage, disc height (DH), visual analogue scale (VAS) for back pain and leg radiation pain, and Oswestry disability index (ODI) were compared by a paired-sample test. Demographics and postoperative slip progression were recorded.</p><p><strong>Results: </strong>A total of 32 patients with a mean age of 72.16 ± 8.07 years were enrolled. 27 underwent L4/5 UBED, 4 underwent L5/S1 UBED, and 1 underwent L3/4 UBED. The postoperative mean vertebral slip percentage increased significantly and the mean DH at the surgical level decreased significantly at the last follow-up. VAS scores for back and leg pain reduced significantly after surgery, and ODI scores improved significantly postoperatively. Only one patient suffered postoperative slip progression. Two cases of postoperative cerebrospinal fluid leakage were reported.</p><p><strong>Conclusions: </strong>The application of UBED to treat LDH and concomitant grade I stable DLS demonstrated effective pain relief and improved quality of life for patients, with a low incidence of postoperative slip progression. UBED is a safe and effective surgical technique for treating older patients with LDH and concomitant grade I stable DLS.</p>","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"347"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810470","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":"Effects of exercise in older adults with osteosarcopenic adiposity: a systematic review and meta-analysis of randomized controlled trials.","authors":"Lei Chen, Wenlu Zhou, Ju Li, Taotao Xu, Zhenyu Shi","doi":"10.1186/s12891-025-08581-4","DOIUrl":"https://doi.org/10.1186/s12891-025-08581-4","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the effects of exercise training on patients with osteosarcopenic adiposity (OSA).</p><p><strong>Methods: </strong>A comprehensive search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases for randomized controlled trials (RCTs) on exercise treatment for OSA patients. The search included both Chinese and English literature up to April 2024. Reference lists and grey literature were also reviewed. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Meta-analysis was performed using RevMan 5.4 software.</p><p><strong>Results: </strong>A total of 7 studies were included in this meta-analysis. Exercise interventions significantly improved bone mineral density (BMD) (MD = 0.0195, 95% CI: 0 to 0.02, P = 0.03), body fat (BF) (MD = -4.0, 95% CI: -5.46 to -2.54, P < 0.01), and hand grip strength (HGS) (MD = 3.13, 95% CI: 0.72 to 5.54, P = 0.01) in patients with OSA. However, no significant differences were observed in skeletal muscle mass index (SMI) (MD = 0.12, 95% CI: -0.26 to 0.50, P = 0.55), gait speed (GS) (SMD = 0.75, 95% CI: -1.26 to 2.76, P = 0.47), or C-reactive protein (CRP) (MD = -0.23, 95% CI: -0.90 to 0.44, P = 0.50).</p><p><strong>Conclusion: </strong>Exercise interventions can effectively improve clinical symptoms and signs in OSA patients to varying degrees, highlighting the importance of exercise in the management of OSA.</p>","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"342"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810487","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":"Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis.","authors":"Zifeng Ye, Yiwei Yuan, Gaoyan Kuang, Liguo Qiu, Xuyi Tan, Zhi Wen, Min Lu","doi":"10.1186/s12891-025-08566-3","DOIUrl":"https://doi.org/10.1186/s12891-025-08566-3","url":null,"abstract":"<p><strong>Objective: </strong>In this systematic review and meta-analysis, we evaluated and compared the efficacy and safety of platelet-rich plasma injection into corticosteroid injection in the treatment of tendinopathy.</p><p><strong>Methods: </strong>We searched PUBMED, EMBASE, Cochrane Library, SCOPUS, and Web of Science to identify randomized controlled trials on the PRP injection versus CS injection in treatment of tendinopathy.The meta-analysis was performed using the Revman 5.4 software.</p><p><strong>Result: </strong>We found 27 RCT studies with a total of 1779 patients enrolled. 8 rotator cuff injuries, 7 humeral external epicondylitis, 10 plantar fasciitis, and 2 tenosynovitis. The results of the meta-analysis showed that there were no significant group differences in the results of patients with rotator cuff injury comparing the pain visual analog scale score and functional measures at 1 month after receiving injection treatment. After three months of receiving PRP treatment, the VAS scores showed greater improvement compared to the CS group(OR = -1.64,95%CI [-2.97,-0.31],P = 0.02), while there was no statistically significant difference in shoulder joint function between the two groups at the 3-6 month post-treatment mark. Patients with plantar fasciitis showed no significant differences in VAS and AOFAS scores after receiving PRP or CS injections at 1 and 3 months. However, at the 6-month mark, the PRP group demonstrated significantly better VAS and AOFAS scores compared to the CS group(OR = -1.41,95%CI [-1.88,-0.44],P < 0.00001; OR = 7.19,95%CI [2.41,11.91],P = 0.003). 1 month after CS injection in patients with tenosynovitis, the VAS score was lower than that of the PRP group; patients with elbow epicondylitis had better improved upper limb function rating scale scores 1 month after CS injection compared to the PRP group. In patients with tenosynovitis, the VAS scores were superior to the CS group six months after PRP treatment(OR = -0.72,95%CI [-1.04,-0.40],P < 0.00001); similarly, patients with lateral epicondylitis exhibited better VAS, DASH scores than the CS group three and twelve months post-PRP treatment(OR = -9.76,95%CI [-10.89,-8.63],P = 0.0002; OR = -0.97,95%CI [-1.87,-0.06],P < 0.0001; OR = -18.03,95%CI [-31.61,-4.46],P = 0.009).</p><p><strong>Conclusion: </strong>PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its mid-term efficacy is superior to that of corticosteroids. However, the long-term efficacy remains to be further clinically verified.</p>","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"339"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810503","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":"Outcomes of non-operatively managed Vancouver Type B1 periprosthetic femur fractures: a multi-center retrospective cohort study.","authors":"Mitchell Crebert, Michael Le, Geoff Murphy, Annamaria Frangos Young, Robert Molnar, Daniel Franks, Michael Symes, Maurice Guzman","doi":"10.1186/s12891-025-08535-w","DOIUrl":"https://doi.org/10.1186/s12891-025-08535-w","url":null,"abstract":"<p><strong>Background: </strong>This retrospective case series evaluated mortality outcomes in patients with Vancouver B1 periprosthetic fractures (PPFs) managed non-operatively using a matched cohort approach. We hypothesize that mortality rates will not significantly differ between operative and non-operative management of Vancouver B1 PPFs, as treatment decisions are likely driven by fracture complexity and patient comorbidities rather than a direct survival benefit of surgical intervention.</p><p><strong>Methods: </strong>Thirty patients with Vancouver B1 PPFs managed non-operatively between 2011 and 2017 across five major Australian trauma centers were identified. Patients were propensity-matched to 60 operatively managed patients, matched by age, ASA score, length of stay, follow-up duration, and fracture sub-type (B1). Mortality rates at 30 days, 1 and 5 years were compared between the non-operative and operatively managed groups. For the non-operative group alone, the impact of weight-bearing status on mortality was assessed.</p><p><strong>Results: </strong>There was no significant difference in mortality rates between the non-operative and operative cohorts at 30-day (3.3%; 1.7%; P = 1.00), 1 year (20.0%; 3.3%; P = 0.09) and 5 years (33.3%; 30.0%; P = 0.78). For the non-operative group alone, there was no significant difference in mortality rates between WBAT and non-WBAT groups at 30 days (7.7%; 0.0%; P = 0.400), 1 year (15.4%; 17.6%; P = 0.839) and 5 years (30.8%; 35.3%; P = 0.781), CONCLUSION: Comparable 5-year mortality rates were identified between non-operatively and operatively managed Vancouver Type B1 periprosthetic femoral fractures. Despite differences in age and comorbidities, non-operative management may be a viable option for selected patients, underscoring the need for further research to refine treatment guidelines.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"348"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810501","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":"Predictive role of preoperative parameters in LAMP outcomes for myelopathy caused by COPLL.","authors":"Hao Yuan, Wei Lei, Wenping Li, Yunlong Zhou, Xufeng Jia, Daxiong Feng, Fei Lei","doi":"10.1186/s12891-025-08577-0","DOIUrl":"https://doi.org/10.1186/s12891-025-08577-0","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to assess the predictive value of preoperative parameters on recovery outcomes in patients with myelopathy caused by cervical ossification of the posterior longitudinal ligament (COPLL) undergoing laminoplasty (LAMP).</p><p><strong>Methods: </strong>A retrospective analysis was performed on myelopathy patients caused by COPLL who underwent LAMP between 2017 and 2020. Preoperative variables, including basic epidemiological characteristics, comorbidities, functional scores, K-line-related parameters, Torg-Pavlov ratio, maximal SCOR and COPLL shape, were analyzed for their predictive influence on postoperative outcomes in cervical spine function, upper and lower extremity function, bladder function, and quality of life (QOL). Binary logistic regression model analyses were used to evaluate predictive accuracy.</p><p><strong>Results: </strong>A total of 84 patients were included in the study. Preoperative parameters were significant predictors of postoperative improvement following LAMP surgery for myelopathy caused by COPLL. K-line-related factors, including K-line (-) (AUC = 0.80) and K-line on sagittal T1WI (-) (AUC = 0.76), were important predictors of cervical spine function improvement. Preoperative QOL scores (AUC = 0.78) also played a significant role in predicting cervical spine function improvement. For upper extremity function, preoperative upper extremity scores were a key predictor (AUC = 0.79), while C4-C6 K-line (-) (AUC = 0.81) was also a relevant factor. Similarly, preoperative lower extremity scores were crucial for predicting lower extremity function improvement (AUC = 0.85), and preoperative QOL scores were significant predictors of QOL improvement (AUC = 0.78). Other parameters, such as the Torg-Pavlov ratio, maximal SCOR, and the shape of COPLL, provided supplementary predictive value, though their influence was secondary to JOACMEQ scores and K-line parameters. Bladder function showed minimal postoperative improvement, with preoperative bladder status and the Torg-Pavlov ratio at C5 being the primary predictors for bladder improvement. Overall, preoperative K-line findings, JOACMEQ scores, and spinal canal measurements provided valuable guidance for postoperative expectations and surgical planning.</p><p><strong>Conclusions: </strong>Preoperative K-line parameters and JOACMEQ scores are robust predictors of functional recovery in myelopathy patients caused by COPLL undergoing LAMP. While Torg-Pavlov ratio, maximal SCOR, and the shape of COPLL offer additional predictive value for overall recovery, they remain useful for preoperative surgical planning. These findings emphasize the importance of comprehensive preoperative assessment to optimize outcomes.</p>","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"341"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810506","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":"A novel classification for aseptic femoral shaft nonunion after intramedullary nailing: a retrospective study.","authors":"Zhi Zhang, Xiong Wang, Qirong Zhou, Xingwen Xu, Jin Cui, Wenqiang Wei, Liehu Cao","doi":"10.1186/s12891-025-08576-1","DOIUrl":"https://doi.org/10.1186/s12891-025-08576-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although intramedullary nailing has been established as the gold standard for treating femoral shaft fractures, nonunion following intramedullary nailing remains a major concern for clinicians, severely affecting patients' walking ability and quality of life. Presently, there are certain controversies and deficiencies in nonunion classification and treatment. Herein, we propose a novel classification system for aseptic femoral shaft nonunion after intramedullary nailing based on X-ray-assessed nailing morphology and stability. Furthermore, we sought to explore the new classification's clinical significance and management implications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study involved the analysis of clinical data collected from 82 patients with aseptic bone nonunion after intramedullary nailing of femoral shaft fractures between 2010 and 2022. The patients were classified into four groups based on intramedullary nailing stability and bone defect existence, as revealed in X-ray images. The four classifications were as follows: Type I (intramedullary nailing is stable without bone defect), Type II (intramedullary nailing is stable with bone defect), Type III (intramedullary nailing is not stable without bone defect), and Type IV (intramedullary nailing is not stable with bone defect). Based on the novel classifications, we introduced individualized treatment methods. Type I patients underwent dynamization, and Type II patients received bone grafting and plate fixation. Type III patients underwent larger intramedullary nail exchange or plate fixation, and Type IV patients received larger intramedullary nail exchange and plate fixation with bone graft or double plate fixation with bone graft. Data on relevant indicators were collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All patients recovered well with no complications. The average surgery times for Types I-IV were 0.4 ± 0.1, 0.8 ± 0.2, 1.1 ± 0.4, and 1.6 ± 0.4 h, respectively. Furthermore, the mean blood loss volumes for Types I-IV were 23.4 ± 4.8, 53.3 ± 8.4, 56.3 ± 7.9, and 125.2 ± 10.8 ml, respectively. The average bone healing time of all 82 patients was 5.1 ± 1.5 months. On the other hand, the mean bone healing times for Types I-IV were 4.6 ± 1.1, 4.7 ± 1.1, 5.1 ± 1.5, and 5.7 ± 1.8 months, respectively. Furthermore, the LEFS scores for Types I-IV were 68.7 ± 3.5, 69.8 ± 3.1, 66.8 ± 3.8, and 68.6 ± 2.9 points, respectively. The mean surgery time and bleeding volume increased gradually from Types I to IV (p &lt; 0.05) but with no significant difference between Types II and III. Moreover, there were no statistical differences in fracture healing times, LEFS scores, age, and nonunion durations across the four classifications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The proposed novel classification system could achieve accurate diagnosis and guidance for clinical management of aseptic femoral shaft nonunion after intramedullary nailing. The corresponding indiv","PeriodicalId":9189,"journal":{"name":"BMC Musculoskeletal Disorders","volume":"26 1","pages":"340"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810461","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}