Background Chronic ankle instability (CAI) is a common sequel of lateral ankle sprain, and proprioceptive training is its first-line treatment, yet the gain differs widely between patients. A prolonged peroneus longus reaction time (PRT) is a hallmark neuromuscular deficit of CAI, but whether it forecasts the training response is unknown. Methods We retrospectively analysed 183 adults with CAI who completed a supervised 12-week proprioceptive programme. Baseline PRT to sudden inversion was measured by surface electromyography. The primary outcome was the change in the Cumberland Ankle Instability Tool (CAIT); the Star Excursion Balance Test (SEBT) was secondary. Associations were tested with Pearson and partial correlation, analysis of covariance, multivariable linear regression and receiver-operating-characteristic analysis. Results CAIT improved from 18.4 to 22.2 points (mean change +3.8, p < 0.001). Baseline PRT was inversely related to the CAIT gain (Pearson r = -0.51, 95% CI -0.61 to -0.39; partial r adjusted for baseline CAIT = -0.57). In the adjusted model PRT remained the strongest predictor (partially standardized β = -2.09 CAIT points per SD, p < 0.001). PRT discriminated non-responders with an area under the curve of 0.78 (95% CI 0.71-0.84). Conclusions A shorter baseline peroneal reaction time was associated with a larger improvement after proprioceptive training. PRT is an inexpensive candidate marker that may help stratify CAI patients, although the retrospective single-centre design warrants prospective confirmation.
Background Although in situ pinning (ISP) is the standard primary treatment for slipped capital femoral epiphysis (SCFE), some patients are left with residual deformity that may lead to long-term complications, including an increased risk of osteoarthritis. This study evaluates the radiographic and clinical outcomes of a secondary corrective procedure, the Pre-Operative computed Tomography-assisted intertrochanteric Flexion (POTOF) osteotomy, for treating these persistent deformities. Methods We retrospectively reviewed patients who underwent a POTOF osteotomy as a secondary procedure for SCFE between 2004 and 2020. Patients with less than two years of follow-up were excluded. We evaluated changes in the modified β angle, incidence of avascular necrosis (AVN), relative joint space (RJS), and the modified Harris Hip Score at the final follow-up. Statistical significance was set at p < 0.05. Results Eleven patients (nine male, two female; 11 hips) were included, with a mean follow-up of 9.0 years. Seven patients had undergone prior ISP, and four were neglected cases. The mean modified β angle significantly improved from 120° to 91° (p < 0.01). No AVN was observed. The mean RJS was 92% (range, 42-128%). The mean modified Harris Hip Score, available for 7 of the 11 hips, was 92.4, indicating good hip function. Conclusions The POTOF osteotomy may serve as a viable secondary procedure for treating residual deformities after SCFE. In this small cohort it improved hip alignment and function, supporting its potential as a treatment option for patients with post-SCFE deformities or neglected cases, although further comparative studies are required to confirm its definitive efficacy.
Purpose There are a limited of studies on determining injury patterns according to motorcycle types and comparing them with other vehicles. We evaluated data on the fractures and dislocations resulting from motorcycle and passenger car collisions. Methods This was a retrospective review of 1149 patients. Patients were divided into four groups based on whether they were e-scooter, moped, motorcycle, or passenger car. Furthermore, using a two-group design, two groups were created: one for all types of motorcycles and another for passenger cars. We evaluated data on the types of fractures and dislocations resulting from motorcycle and passenger car collisions, whether they required surgical intervention, hospitalization, intensive care unit (ICU) rates, injury severity scores (ISS), concomitant injuries, and the mechanism of injury. Results 174 (15.1%) e-scooter, 135 (11.7%) motorcycle, 156 (13.6%) moped, and 684 (59.5%) passenger car riders were represented in the study. Lower extremity fractures occurred at a rate of 427 (37.2%). Of the fractures, 126 (11.0%) were open fractures, while 416 (36.2%) extended into the joint. For the ISS, the median values were 9.0 (7.0-14.0) a for e-scooters, 14.0 (10.0-18.0) b for motorcycle riders, 10.0 (8.0-16.0) b for moped riders, and 12.0 (8.0-17.0) b for car passenger riders, and these differences were statistically significant (p<0.001). Conclusion The fractures observed in motorcycle riders tended to be more open fractures and more likely to extend into the joint. The low speed of e-scooter collisions may reduce the severity of trauma; nevertheless, falls occurring at low to moderate speeds among motorcycle and moped riders can lead to more serious injuries.
Background Total knee arthroplasty (TKA) is among the most frequently performed orthopedic procedures worldwide. Postoperative outcomes are commonly assessed through routine clinical follow-up; however, a substantial proportion of patients do not adhere to scheduled visits and are classified as lost to follow-up (LFU). Data regarding patient-reported outcomes in this population remain limited and conflicting. Methods This retrospective, single-center cohort study included patients aged ≥50 years who underwent primary TKA between January 2018 and March 2020, allowing for a minimum follow-up of 2 years. Patients who attended one or no routine postoperative clinic visits during the first postoperative year were classified as LFU and compared with patients who attended two or more visits (FU). At least 2 years postoperatively, patients completed the Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and a numeric rating scale for pain. Group comparisons were performed using Wilcoxon rank-sum test and independent-samples. Multivariable logistic regression analyses assessed associations between patient-reported outcomes and loss to follow-up while adjusting for age, sex, body mass index, ethnicity, and Charlson Comorbidity Index (CCI). Results A total of 250 patients were included, of whom 63 (25.2%) were classified as LFU. Patients in the LFU group demonstrated significantly higher OKS and KOOS scores and lower pain scores compared with the FU group. Multivariable analyses confirmed that higher functional scores and lower pain levels were independently associated with loss to follow-up. Conclusions Patients lost to routine postoperative follow-up after TKA reported superior functional outcomes and lower pain levels. These findings suggest that favorable recovery may reduce the perceived need for continued follow-up, with implications for optimizing postoperative surveillance strategies.
Purpose While diabetic nephropathy (DN) is a known risk factor for poor outcomes in major surgery, its specific impact on perioperative complications following primary total knee arthroplasty (TKA) has not been well-quantified in large-scale studies. This study aimed to determine the correlation of pre-existing DN on perioperative complications, mortality, and healthcare resource utilization in patients undergoing primary TKA. Methods A retrospective cohort study utilized the US National Inpatient Sample (2016–2019). Patients undergoing primary TKA were stratified into DN and non-DN cohorts using ICD-10 codes, excluding end-stage renal disease or revision cases. A 1:1 propensity score-matched analysis was performed to balance demographics, hospital characteristics, and 30 comorbidities between cohorts. Outcomes included surgical/medical complications, mortality, length of stay (LOS), and hospitalization costs. Multivariable logistic regression analyzed associations pre- and post-PSM. Results DN prevalence increased significantly from 1.2% (2016) to 3.4% (2019). After PSM, DN patients had significantly higher adjusted risks of multiple complications. Surgical complications included increased transfusion (aOR=1.64), intubation/mechanical ventilation (aOR=1.52), periprosthetic infection (aOR=1.38). Medical complications included pulmonary edema (aOR=3.40), acute myocardial infarction (aOR=2.13), stroke (aOR=1.43), atrial fibrillation/flutter (aOR=1.09), postoperative delirium (aOR=1.66), urinary retention (aOR=1.26), and urinary tract infection (aOR=1.25). Resource utilization significantly increased, with higher odds of extended LOS (aOR=1.44) and elevated hospitalization costs (aOR=1.19). Conclusion These findings underscore that DN is significantly associated with a distinct pattern of TKA complications, advocating for targeted perioperative strategies to mitigate risks in this growing population.
Background Symptomatic same-level recurrence remains a concern after percutaneous endoscopic lumbar discectomy (PELD). We compared PELD plus endoscopic annular suture with PELD alone. Methods This single-center prospective observational cohort enrolled patients from January 2023 through October 2024. Treatment was selected through shared clinician-patient decision-making. Propensity scores based on eight baseline variables were matched 1:1, yielding 51 patients per group. Clinical scores were assessed through 12 months; symptomatic recurrence was followed for up to 23.9 months. Kaplan-Meier and exploratory Cox analyses were used. Results Both groups improved. At 6 and 12 months, the suture group had better Japanese Orthopaedic Association and Oswestry Disability Index scores, whereas 12-month pain scores were similar. Symptomatic recurrence occurred in 13/51 controls (25.49%) and 4/51 suture patients (7.84%; P = 0.017). Eighteen-month recurrence-free estimates were 75.2% (95% CI 59.2%–85.6%) and 94.9% (95% CI 80.3%–98.7%), respectively (log-rank P = 0.028). Reoperation (10/51 vs 4/51; P = 0.084) and complications (4/51 vs 3/51) did not differ significantly. Subgroup estimates were limited by only 17 events. Conclusions Annular suture was associated with better short-to midterm function and fewer symptomatic recurrences, but causality and long-term effectiveness remain uncertain. Larger multicenter studies with longer, imaging-based follow-up are required.
Introduction Diabetes and obesity are associated with increased risk of complications following total knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a modality for optimizing weight and glycemic control in the perioperative period. This study aims to compare 2-year postoperative complications between GLP-1 RA users and non-users, using laterality-verified methodology to ensure ipsilateral outcome attribution. Methods A retrospective query of the TriNetX database identified patients who underwent TKA and used GLP-1 RAs within a 1-year preoperative period. GLP-1 RA patients were 1:1 propensity matched to non-user controls for demographics and confounding comorbidities. Laterality was assessed independently to ensure ipsilateral TKA and corresponding complication. Outcomes analyzed were TKA revision, periprosthetic joint infection (PJI), mechanical loosening, periprosthetic fracture, and other mechanical complications within a 2-year postoperative period. Results were further stratified to isolate outcomes among diabetic patients. Results were reported as risk ratios, 95% confidence intervals, and P values. Results GLP-1 RA users experienced significantly lower rates of PJI (1.5% vs. 2.0%; RR 0.74; 95% CI 0.57, 0.96; P = 0.02) compared to non-users in a 2-year postoperative period. Among diabetic patients, GLP-1 RA users had significantly lower PJI rates (1.7% vs. 2.5%; RR 0.68; 95% CI 0.52, 0.89; P < 0.01). There were no significant differences between rates of revision, mechanical loosening, periprosthetic fractures, or other mechanical complications in the overall or diabetic-only cohorts. Conclusion GLP-1 RA use was associated with a reduced risk of PJI in a 2-year postoperative period without any significant differences in mechanical outcomes in both overall and diabetic-only cohorts. This laterality-verified analysis provides more accurate outcome attribution than prior database studies and supports a selective protective effect of GLP-1 RAs against infection-related rather than mechanical complications following TKA.
Introduction Giant cell tumour of bone is a benign but locally aggressive condition associated with a risk of recurrence and functional impairment. This study aimed to evaluate the clinical presentation, functional outcomes, and oncological outcomes of patients with giant cell tumour of bone treated at a tertiary orthopaedic oncology centre, with particular emphasis on local recurrence, pulmonary metastasis, surgical management, and survival. Methods A single-centre retrospective cohort study was conducted involving 151 patients with histologically confirmed giant cell tumour of bone treated between 2006 and 2023. Demographic characteristics, tumour location, treatment modality, recurrence, metastasis, and survival outcomes were analysed. Functional outcomes were assessed using the Musculoskeletal Tumour Society (MSTS) score and the Toronto Extremity Salvage Score (TESS) in a subset of 114 patients (75.5%) . Time-to-event outcomes, including local recurrence-free survival, were analysed using Kaplan–Meier methods . The mean duration of follow-up was 81.7 ± 63.8 months. Results Local recurrence occurred in 17 patients (11.3%), with a 5-year local recurrence-free survival rate of 88.1%. Pulmonary metastasis was observed in 5 patients (3.3%). Among the 114 patients with available clinical and functional data, intralesional curettage was associated with significantly higher functional scores than wide resection (MSTS: 87.4 ± 8.1 vs 70.9 ± 14.3, p < 0.001; TESS: 89.9 ± 6.8 vs 80.1 ± 11.2, p < 0.001) for tumours in the lower limb. No significant functional differences were observed between surgical approaches in the upper limb. The five-year overall survival rate was 94.7%. Five-year disease-free survival and event-free survival rates were 87.7% and 82.7%, respectively. Median survival outcomes were not reached. Conclusion Giant cell tumour of bone demonstrates excellent long-term survival, with local recurrence representing the primary oncological challenge. Intralesional curettage provides superior functional outcomes for selected lower-limb tumours, while wide resection remains essential for aggressive or recurrent disease.
Purpose Dermabond Prineo, a 2-octyl cyanoacrylate adhesive mesh dressing, is widely used in knee arthroplasty for rapid watertight closure. Allergic contact dermatitis (ACD) has been reported in approximately 5% of Western cohorts, with repeat exposure as a key risk factor. This study evaluated incidence, risk factors, and short-term outcomes in an Asian population. Methods A single-centre retrospective cohort study included 290 consecutive patients undergoing primary total or unicompartmental knee arthroplasty (2022–2023) with 6-month follow-up. ACD was diagnosed clinically. Outcomes included ROM, KSS, KSF, OKS, and SF-36 scores. Logistic regression identified risk factors. Results ACD occurred in 19 patients (6.6%) at a mean of 21 days. No cases progressed to prosthetic joint infection. Younger age (OR 0.90, p=0.003) and prior Dermabond exposure (adjusted OR 3.12, p=0.034) independently predicted ACD. Six-month outcomes were comparable between groups. Conclusion ACD is uncommon and does not affect short-term outcomes, though younger and previously exposed patients are at higher risk.
This literature review aimed to synthesize the current evidence on the developmental processes of the femoral trochlea, both non-dysplastic and dysplastic. A comprehensive literature review was conducted in three databases (PubMed, Google Scholar, and Sofia) for studies published up to June 2025 using predefined keywords related to trochlear morphology and development. Studies addressing the development of both dysplastic and non-dysplastic trochleae were included after a stepwise screening of titles, abstracts, and full texts. Eleven studies were included, three were prenatal and eight were postnatal. Most studies relied only on the sulcus angle to characterize trochlear dysplasia. In non-dysplastic trochlea, trochlear morphology starts in utero, with a relatively flat osseous groove at birth that is functionally compensated by a well-formed cartilaginous trochlea, followed by progressive osseous deepening and integration with the cartilaginous morphology until skeletal maturity. In dysplastic trochlea, while a genetic predisposition appears involved, altered patellar tracking and insufficient patellar engagement during growth may also contribute a developmental component of dysplasia. Future studies should combine longitudinal follow-up with comprehensive three-dimensional assessment of trochlear morphology to improve our understanding of femoral trochlear development and the pathogenesis of trochlear dysplasia.
BackgroundPathological fractures (PFs) are clinically important skeletal-related events in patients with bone metastases from solid tumors and may negatively affect survival. This meta-analysis aimed to quantify the association between PFs and overall survival (OS) in patients with metastatic solid cancers.MethodsThis systematic review and meta-analysis was conducted in accordance with PRISMA 2020 using a PICOS-defined protocol. PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to 2025 without language restrictions. Eligible studies included adults with metastatic solid tumors, compared patients with and without PFs, and reported OS using hazard ratios (HRs). Tumor types were pooled a priori because the included studies evaluated the same exposure-comparator-outcome framework across metastatic solid tumors. Random-effects models were used, and heterogeneity was explored through moderator analyses and meta-regression. Two reviewers independently screened records, extracted data, and assessed risk of bias using MINORS for observational studies and the Cochrane tool for randomized trials.ResultsFrom 198 records, four studies comprising seven cohorts and 3,607 participants met the inclusion criteria. Random-effects pooling showed that PFs were significantly associated with poorer OS compared with no PFs (pooled HR 1.40, 95% CI 1.08-1.81; p = 0.010). However, heterogeneity was substantial (I2 = 92.6%), indicating that the pooled estimate should be interpreted cautiously. Meta-regression suggested a positive association between publication year and effect size (β = 0.041; p = 0.041), whereas primary cancer subgrouping was not a significant moderator. Funnel-plot asymmetry and Egger's test suggested possible small-study effects.ConclusionsPFs appear to be associated with worse OS in patients with metastatic solid tumors, highlighting the importance of fracture prevention, early identification of impending fractures, and multidisciplinary care. Nevertheless, the small evidence base, substantial heterogeneity, and possible publication bias warrant cautious interpretation. Prospective studies with standardized PF definitions and adjusted survival analyses are needed.
Background Re-excision for recurrent bone and soft tissue tumor involves increased surgical morbidity, often with significant bone and soft tissue loss associated with removal of indwelling implants. The case series demonstrates Wide resection, freezing and implant retention (WFIR) after recurrent bone and soft tissue tumor with previous implant retention. Methods A retrospective review was conducted on 11 consecutive patients who underwent WFIR for recurrent extremity musculoskeletal tumors between July 2011 and July 2023 at a tertiary referral center in Taipei, Taiwan. All procedures were performed by a single fellowship-trained musculoskeletal oncologic surgeon, with diagnoses confirmed by two independent pathologists. Outcomes included implant survival, local recurrence, infection, wound complications, reoperation, and amputation. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score. Additionally, 2-year limb preservation and local recurrence rates were recorded. Results Eleven patients (mean age 46 years) were included, with the femur being the most common site (n=9). Osteosarcoma was the most frequent diagnosis (n=5). Four patients had prior unplanned excisions. Two patients underwent amputation due to recurrence or infection. Implant retention was achieved in 81.8% of cases, with a local recurrence rate of 9.1%. Implant retention was achieved in the remaining cases without major complications. The mean MSTS score was 95.2%. Conclusion WFIR provides satisfactory implant retention, acceptable oncological control, and favorable functional outcomes in recurrent musculoskeletal tumors, and may reduce morbidity associated with implant removal and extensive tissue loss.
Purpose This article aims at studying the correlation between Trabecular Bone Score and fragility fracture risk in a population of Lebanese postmenopausal women aged 65 years and older. Methods A retrospective cohort study was done on 114 postmenopausal Lebanese women, who underwent bone densitometry (DEXA scan) at Bellevue Medical Center, between the years 2018 and 2020. These women were then followed for the presence or absence of fractures during the 5 years following their scan results. A bivariate and multivariate logistic regression was computed to analyze the results. Results Our logistic regression showed that neither TBS nor BMD were significant predictors of fragility fracture occurrence during the next five year follow up. In the unadjusted model, TBS was not associated with fracture occurrence (OR=0.14; 95% CI: 0.003-5.69; p=0.296). Even after adjustment, this association remained non-significant (aOR=0.98; 95% CI: 0.01-67.55; p=0.992). Conclusion The Trabecular Bone Score failed to serve as a predictability tool for fragility fractures in elderly postmenopausal Lebanese women.
Purpose To evaluate structural factors associated with Baker’s cyst volume and determine whether cyst enlargement is related to medial meniscus posterior root tear (MMPRT), medial meniscus extrusion (MME), posterior tibial slope (PTS), and radiographic osteoarthritis severity. Methods This retrospective study included 876 knee MRI examinations with MRI-confirmed Baker’s cysts after predefined exclusions. Baker’s cyst volume, MMPRT status, MME, PTS, and Kellgren–Lawrence osteoarthritis grade were assessed using standardized imaging protocols. Factors associated with cyst volume were evaluated using multivariable linear regression. Logistic regression and receiver operating characteristic analysis were performed to assess the relationship between cyst volume and MMPRT. Measurement reliability was evaluated using intraclass correlation coefficients. Results MMPRT was independently associated with larger Baker’s cyst volume (p = 0.004). Greater PTS was also associated with increased cyst volume, with each 1° increase corresponding to a significant volume increase (p = 0.012). Increasing Kellgren–Lawrence grade remained independently associated with larger cyst volume (p < 0.001), and MME showed an independent but modest association (p = 0.044). The final regression model was significant (F (8,867) = 23.45, p < 0.001) and explained 17.8% of the variance. ROC analysis identified 10.16 cm 3 as the optimal cyst volume threshold for identifying MMPRT; however, discriminative performance was modest, indicating that cyst volume should not be interpreted as a standalone diagnostic marker. ICC values ranged from 0.79 to 0.91. Conclusion Baker’s cyst enlargement is associated with MMPRT, increased PTS, greater MME, and increasing osteoarthritis severity. Larger cysts may prompt careful evaluation of the medial meniscus posterior root and degenerative joint burden on routine knee MRI, but cyst volume should be interpreted together with other structural imaging findings.
Purpose To evaluate the radiologic and clinical outcomes of a novel scapular anatomical plate designed for fixation of glenoid articular and periarticular fractures. Methods This prospective case series included 14 patients with scapular fractures treated between 2020 and 2024. Indications for surgery were intra-articular step-off >3 mm, glenoid medialization >20 mm, or glenoid angulation >30°. All patients underwent open reduction and internal fixation using the newly developed anatomical plate and were followed for at least 12 months. Radiologic outcomes were assessed using computed tomography, including intra-articular step-off, lateral border offset, and glenoid angular deformity. Clinical outcomes were evaluated using shoulder range of motion, Disabilities of the Arm, Shoulder and Hand (DASH) score, modified American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) for pain. Results Six patients had intra-articular fractures and eight had extra-articular fractures. Mean intra-articular step-off improved from 6.3 mm to 1.9 mm, lateral border offset from 21.2 mm to 2.3 mm, and glenoid angular deformity from 30.1° to near-anatomical alignment postoperatively. No articular screw penetration was observed on postoperative CT. All fractures achieved radiographic union without loss of reduction or implant-related complications. At 12 months, mean forward flexion was 136.4°, DASH score 24.5, modified ASES score 72.9, and VAS score 3.1. Conclusion The novel scapular anatomical plate provided stable fixation with satisfactory radiologic restoration and favorable clinical outcomes for glenoid articular and periarticular fractures.
Osteochondral lesions of the talus are injuries of the talar dome that are often overlooked until late disease progression. Throughout history, several techniques and treatment modalities have been used in the management of these lesions with an ongoing debate as to which approach is superior to the other, and what the indications and rehabilitation protocols are for each modality. Moreover, the introduction of adjunct therapies such as extracorporeal shockwave therapy and injectables widened the scope of the treatment. While most surgical and nonsurgical approaches have demonstrated satisfactory outcomes, an ideal treatment algorithm is still elusive. This literature review meticulously studies major trends in the different management techniques of osteochondral lesions of the talus, describing the mostly used protocols, comparative results, and complication rates. It also highlights the latest updates on the use of injectables and adjunct therapies, aiming to guide the clinical decision making in treating this pathology.
Urban orthopaedic practice in India is undergoing profound organisational change driven by population ageing, an increasing burden of musculoskeletal disease, expanding subspecialisation, technological advances, and growing regulatory and quality-reporting requirements. These developments have renewed interest in organisational models capable of supporting coordinated, high-quality musculoskeletal care while maintaining clinical efficiency and professional sustainability. This structured narrative review evaluates contemporary organisational models of orthopaedic practice, with particular emphasis on structured group practice, within the Indian healthcare context. A structured narrative review was undertaken using PubMed as the primary database, supplemented by targeted Google Scholar searches and manual reference screening. Forty-five publications meeting predefined eligibility criteria were included in the final narrative synthesis. Evidence relating to orthopaedic practice organisation, subspecialisation, volume–outcome relationships, multidisciplinary care, clinical governance, registry participation, workforce wellbeing, health-system organisation, and practice sustainability was synthesised. The available literature suggests that structured group practice may facilitate subspecialty-focused care, multidisciplinary collaboration, standardisation of perioperative pathways, registry participation, continuous quality improvement, and equitable workload distribution. However, direct comparative evidence demonstrating superiority over well-organised solo or small-group practice remains limited, particularly in India. Many reported advantages appear to arise from effective evidence-based organisational processes rather than organisational size alone. The available evidence suggests that organisational models capable of supporting multidisciplinary care, clinical governance, and evidence-based organisational processes are increasingly important for contemporary orthopaedic practice. Structured group practice represents one context-dependent organisational approach that may be particularly relevant to urban India. The review identifies important evidence gaps, particularly the lack of comparative Indian studies, and highlights priorities for future research.
Background Total Knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis (KOA), but healthcare resource utilization has become an increasing concern in an aging surgical population. Hospital Frailty Risk Score (HFRS) has been associated with adverse surgical outcomes, but its impact on resource utilization after TKA remains unclear. Using a large national database, this study aims to evaluate the association between HFRS-defined frailty risk categories and healthcare resource utilization after TKA, including length of stay (LOS), total charges (TOTCHG), and non-routine discharge. Methods Data on patients undergoing TKA were extracted from the National Inpatient Sample database. Patients were categorized into an analytic cohort and a validation cohort. We used the HFRS to identify frailty: low frailty risk (HFRS < 5), intermediate frailty risk (5–15), and high frailty risk (HFRS > 15). Patient demographic, hospital characteristics, and comorbidities were assessed. Logistic regression analyses, stratified analyses, ROC curve analyses, and sensitivity analyses were performed to evaluate associations, subgroup consistency, and discriminative performance. Results A total of 622,574 patients undergoing TKA for primary KOA were identified. Patients were categorized into low (n = 439,343), intermediate (n = 29,637), and high (n = 223) frailty risk groups according to the HFRS. In multivariable logistic regression analyses, higher HFRS-defined frailty risk categories were independently associated with increased healthcare resource utilization and complications. Compared with patients with low frailty risk, those with intermediate and high frailty risk had significantly higher odds of prolonged LOS, increased TOTCHG, non-routine discharge, any complication, and major complications (all P < 0.001). Sensitivity analyses using a binary classification of HFRS-defined frailty yielded consistent findings. Conclusion HFRS-defined frailty risk categories are independently associated with increased healthcare resource utilization and postoperative complications after TKA. These findings support the potential utility of HFRS for preoperative risk stratification and individualized perioperative care planning.
BackgroundThe modified anterior neurovascular interval approach provides direct access to the anterior coronoid while preserving the flexor-pronator origin. However, the narrow working corridor makes conventional mini-plate fixation technically challenging, often requiring repeated contouring and supplementary lag screws. We developed a specialized anatomical hook-plate (SAHP) and compared it with conventional mini-plate (CMP) fixation.MethodsWe retrospectively reviewed patients with unstable ulnar coronoid fractures (Regan-Morrey type II/III) treated via the anterior approach between January 2022 and January 2025. Twenty-five consecutive patients treated with SAHP were matched 1:1 with 25 CMP controls. Matching criteria included injury mechanism, Regan-Morrey classification, dominant fracture zone, and concomitant procedures. Operative time, supplementary lag screw use, union time, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, flexion-extension arc, and complications were compared.ResultsAll 50 patients completed follow-up (median, 12.5 months; range, 12-20 months). Operative time was significantly shorter in the SAHP group than in the CMP group (93.2 ± 26.8 vs. 112.4 ± 30.5 min; mean difference -19.2 min, 95% CI -29.8 to -8.6; P = 0.001). Supplementary lag screws were required in 15 patients (60.0%) in the CMP group and in none of the SAHP group (P < 0.001). All fractures achieved union. At final follow-up, functional outcomes (MEPS, DASH, flexion-extension arc) were similar between groups (all P > 0.05). No fixation failure or reoperation occurred.ConclusionsFor coronoid fractures requiring anterior buttress fixation, the SAHP simplifies the procedure by reducing operative time and eliminating the need for supplementary lag screws compared to conventional mini-plates. This may lower the technical barrier for this challenging approach while providing comparable short-term outcomes.
Background Split-thickness skin grafting (STSG) is commonly used for traumatic soft-tissue defects; however, graft instability and suboptimal scar outcomes remain concerns. Negative pressure wound therapy (NPWT) has emerged as an alternative fixation method to the conventional tie-over dressing. This study compared clinical outcomes between NPWT and tie-over fixation and evaluated whether defect size influenced their comparative effectiveness. Methods Seventy-five patients who underwent STSG for traumatic soft-tissue defects between March 2020 and February 2025 were retrospectively reviewed. Patients were divided according to fixation method into NPWT (n = 38) and tie-over dressing groups (n = 37). Outcomes included operative time, complete graft-take rate, postoperative complications, and Vancouver Scar Scale (VSS) scores at 2 weeks and 6 months. Subgroup analysis was performed according to defect size (<100 cm 2 vs ≥100 cm 2 ). Results At 2 weeks postoperatively, the NPWT group demonstrated significantly lower VSS scores for vascularity, pliability, and height compared with the tie-over group (p < 0.05). At 6 months, significantly lower pliability scores were observed in the NPWT group; in the ≥100 cm 2 subgroup, NPWT also showed a significantly lower height score (p < 0.05). Operative time was significantly shorter in the NPWT group than in the tie-over group (p < 0.001). Complete graft-take rates were comparable overall; however, in defects ≥100 cm 2 , NPWT achieved a significantly higher complete graft-take rate (p = 0.048). Conclusions NPWT was associated with shorter operative time and early scar-related outcomes, particularly in larger defects. However, given the retrospective design and limited subgroup size, these findings should be interpreted cautiously, and NPWT may be considered as a useful option in selected mechanically demanding cases rather than a universal fixation method.
