OBJECTIVES:This study aims to define the greater sciatic notch (GSN)-based transcolumnar "magic screw" corridor in the acetabulum and to assess its morphometric characteristics and anatomical feasibility according to quadrilateral plate (QP) morphology. MATERIALS AND METHODS:Between November 2025 and January 2026, three-dimensional morphometric analysis was performed on pelvic CT reconstructions of 90 adults (180 acetabulae) with intact pelvic bones and no evidence of hip or pelvic pathology. Using Mimics, pelvic models were reconstructed and a virtual 6.5-mm cannulated screw was advanced from the midpoint of the GSN toward the anterior column along a transcolumnar intraosseous trajectory. Bilateral trajectory length, angulation, and QP thickness were recorded. Differences by sex and side, age associations, and anatomical feasibility ("easy" versus "hard") were analyzed based on anatomical corridor constraints. RESULTS:Of the patients included in the study, 42 were male and 48 were female with a mean age of 49.88 ± 17.18 (range, 19 to 86) years. The defined GSN-based transcolumnar screw corridor was anatomically feasible in 94.44% of cases. Mean posterior acetabular screw length was 74.16 ± 7.49 mm right and 73.21 ± 6.90 mm left. Mean GSN entry segment length was 22.95 ± 4.14 mm right and 23.48 ± 4.34 mm left. Mean acetabular screw angles were 125.86° ± 6.05° right and 124.26° ± 5.24° left, with a small but significant right-left difference (p = 0.004). The QP morphology demonstrated substantial variability: mean maximum thickness was 14.87 ± 2.75 mm right and 14.77 ± 2.82 mm left, while minimum thickness was 3.46 ± 1.37 mm right and 3.48 ± 1.32 mm left. Men had significantly greater superior and posterior acetabular screw lengths and markedly thicker QP parameters compared with women (all p ≤ 0.027), with large effect sizes for QP thickness (d > 1.0). CONCLUSION:A GSN-based transcolumnar magic screw corridor appears anatomically feasible in most adult pelves and provides a quantifiable intraosseous trajectory reaching both acetabular columns. Quadrilateral plate thickness emerges as the main anatomical limiting factor, particularly in female pelves and in cases categorized as corridor-constrained.
OBJECTIVES:This study aims to evaluate the effects of BPC-157, synthetic thymosin beta-4 (TB-500), and their combination on Achilles tendon healing using biomechanical, histopathological, histochemical, and immunohistochemical analyses in a rat model. MATERIALS AND METHODS:Thirty-two male Sprague-Dawley rats, each aged 12 weeks and weighing approximately 330 g, underwent standardized Achilles tendon transection and repair and were randomly assigned to four groups, with eight rats in each group: control, BPC-157 (10 µg/kg/day), TB-500 (60 µg/kg/day), and combined BPC-157 + TB-500 (BPC + TB). Treatments were administered intraperitoneally for four weeks postoperatively. At four weeks, tendons were harvested for biomechanical testing or histological evaluation. Maximum load to failure was assessed biomechanically. Histological and histochemical analyses included hematoxylin-eosin, Masson trichrome, Alcian blue, and Sirius red staining and were evaluated using Bonar and Movin scoring systems. Expression of collagen types I and III was assessed immunohistochemically and semiquantified using H-score analysis. RESULTS:Biomechanical testing revealed higher maximum load to failure values in the BPC-157 and TB-500 groups compared to controls, reaching statistical significance in the TB-500 group (p < 0.05). Histopathological evaluation demonstrated significantly lower total Bonar scores in the TB-500 group (p = 0.016) and significantly lower total Movin scores in the TB-500 and BPC + TB groups (p = 0.017 and p = 0.040, respectively) relative to controls, indicating improved tendon architecture, collagen alignment, and reduced degenerative changes. The BPC-157 group showed numerically lower scores without reaching statistical significance for total scores. Sirius red birefringence analysis showed increased type I collagen organization and altered type III collagen distribution in treatment groups, particularly in the TB-500 group, suggesting progression toward matrix maturation. Immunohistochemical analysis revealed no significant differences in collagen type I expression among groups, whereas collagen type III expression differed significantly, consistent with histochemical findings. Combined BPC-157 and TB-500 treatment did not confer additional benefits compared to either agent alone. CONCLUSION:In this exploratory rat model study, both BPC-157 and TB-500 were associated with improved histopathological parameters and extracellular matrix organization during early Achilles tendon repair, with TB-500 additionally demonstrating a significant biomechanical advantage at four weeks. The absence of additive effects with combination therapy may reflect convergence on shared downstream pathways; however, this hypothesis requires further experimental confirmation. These preliminary findings indicate that both peptides warrant further investigation as candidate adjuncts to tendon repair, pending dose-optimization and longer-term studies.
OBJECTIVES:This study aims to evaluate the feasibility, safety, and peri-implant bone formation of augmenting a proximal femoral nail (PFN) helical blade with a calcium sulfate/hydroxyapatite (CaS/HA) biomaterial combined with systemic zoledronic acid (ZA). PATIENTS AND METHODS:This single-center, two-arm, parallel-group, randomized-controlled pilot study included a total of 20 patients with osteoporotic trochanteric fractures (TFs) between December 2023 and January 2025. The patients were randomized into a control group receiving standard PFN or an intervention group receiving PFN augmented with CaS/HA biomaterial. All patients received cefazoline and doxycycline for infection prophylaxis. On postoperative Day 7, both groups received a single intravenous infusion of ZA. The primary outcome was the change in bone mineral density (BMD) defined by previously published peri-implant regions-of-interest at one week and six months postoperatively. Secondary outcomes included tip-apex distance (TAD) for assessing blade migration and the Harris Hip Score (HHS) for functional evaluation. RESULTS:Of a total of 20 patients included in the study, 6 were male and 14 were female with a median age of 81 (range, 65 to 90) years. Regarding intervention delivery, all 10 randomly assigned patients received their intended treatment. While 19 of the 20 randomly assigned patients received the intended treatment; one patient died within the first week and did not receive ZA. The required data for clinical analysis (change in peri-implant BMD, TAD, fracture union, and HHS) could only be extracted for five patients in the control group and five patients in the intervention group. There were no intraoperative complications, and no adverse effects related to the CaS/HA biomaterial were reported. Ten patients were included for the outcome analysis. The intervention group demonstrated a more pronounced increase in peri-implant BMD compared to controls. Additionally, TAD changed more in the control group. Functional evaluation revealed that the intervention group demonstrated a slightly greater HHS improvement. CONCLUSION:Our study results suggest that augmentation using the CaS/HA and ZA is a feasible and safe procedure for patients with osteoporotic TF. Preliminary findings indicate a potential trend toward enhanced peri-implant bone formation in the intervention group.
OBJECTIVES:This study aims to compare the rates of medical complication and mortality following initial bipolar hemiarthroplasty (bHA) and reoperation procedures, as well as between different causes of reoperation (nonseptic vs. septic). PATIENTS AND METHODS:The retrospective study included 118 patients undergoing reoperation after bHA for femoral neck fractures between January 2002 and December 2022. The primary outcomes included in-hospital complications, readmission, and mortality events, while secondary outcomes included length of hospital stay, transfusion rates, and estimated blood loss. These outcomes were compared between each patient's initial bHA and their subsequent reoperation procedure. The two cohorts were matched using propensity scores based on age, sex, and Charlson Comorbidity Index to compare outcomes between nonseptic and septic causes of reoperation. RESULTS:Of the 118 patients, 64 were male and 54 were female. The mean age was 77.8 ± 7.9 years, with a range of 61 to 98 years. The in-hospital complication rate was higher after reoperation than after initial bHA (15.3% vs. 1.7%, p < 0.001). Conversely, the readmission rate was higher after the initial procedure (60.2% vs. 23.7%, p < 0.001), mainly due to surgical complications. Patients undergoing reoperation had longer hospital stays, higher transfusion requirements, and more frequently received general anesthesia compared to the initial procedure (p < 0.05). In the matched cohort, septic group had higher in-hospital complication rates than the nonseptic group (23.5% vs. 3.9%, p = 0.004), while readmission and mortality rates were comparable. CONCLUSION:Reoperations after bHA carry a higher risk of medical complications. This risk is particularly pronounced in cases related to septic conditions, underscoring the greater impact of reoperation and careful clinical attention.
OBJECTIVES:This study aims to investigate whether second metacarpal cortical percentage (2MCP) and psoas muscle index (PMI) were associated with loss of reduction after closed reduction and cast immobilization. PATIENTS AND METHODS:A total of 91 adult female patients with distal radius fractures (DRFs) treated with closed reduction and cast immobilization between January 2014 and June 2025 were retrospectively analyzed. Patients with standardized serial radiographs and lumbar computed tomography (CT) performed within ± 3 months of injury were included. Clinical characteristics, AO/OTA fracture type, Lafontaine instability criteria, lumbar CT densitometry T-scores, 2MCP, and PMI were evaluated. Loss of reduction was defined radiographically during follow-up. Multivariate logistic regression was performed using predefined cut-off values, and receiver operating characteristic (ROC) curve analysis was used to explore cut-off values for 2MCP and PMI. RESULTS:The mean age was 63.0 ± 8.2 (range, 44 to 84) years. Loss of reduction occurred in 23 patients (25.3%). In group comparisons, AO/OTA Type C fracture pattern, Lafontaine instability, CT densitometry-defined osteoporosis, 2MCP-defined osteoporosis, and low PMI were more frequent among patients with loss of reduction. In the multivariate analysis, 2MCP-defined osteoporosis was independently associated with loss of reduction (adjusted OR = 7.22; 95% CI: 1.16-45.06; p = 0.034). Low PMI was also independently associated with loss of reduction (adjusted OR = 25.52; 95% CI: 5.33-122.14; p < 0.001). The ROC curve analysis identified cut-off values of 48% for 2MCP and 3.65 for PMI. CONCLUSION:Our study results showed that 2MCP-defined osteoporosis and low PMI were independently associated with loss of reduction after non-operative treatment of DRFs in female patients. These imaging-based parameters may support exploratory risk stratification.
OBJECTIVES:This study aims to evaluate the midterm clinical outcomes of patients with complex clubfoot treated using the Ponseti method and to assess the sustainability of deformity correction over time. PATIENTS AND METHODS:Between January 2016 and January 2021, a total of 38 feet in 26 patients with complex clubfoot treated using the modified Ponseti method were retrospectively analyzed. The patients were divided into two groups: those treated entirely in our institution (study center group) and those referred from external centers after unsuccessful initial treatment (external center group). Clinical severity was assessed using the Pirani score, and ankle dorsiflexion (DF) was measured during follow-up. Functional outcomes were evaluated using the Pirani-Based Score (PBS) and the Oxford Ankle Foot Questionnaire (OxAFQ). Relapse rates, additional procedures, and treatment success were analyzed. Independent predictors of outcomes were identified. RESULTS:Of a total of 26 patients included in the study, 2 were male and 24 were female with a mean age of 6.78 ± 1.29 (range, 5 to 8) years. Of these patients, 14 (53.8%) had unilateral involvement, while 12 (46.2%) had bilateral deformity. The external clinic group presented at a significantly later age than the study center group (p < 0.001), while baseline deformity severity was comparable. Pirani scores and DF measurements improved significantly in both groups, with no intergroup differences during follow-up (p > 0.05). Functional outcomes showed a significant difference in PBS scores, which were higher in the external clinic group (p = 0.045), indicating worse functional performance, while the OxAFQ scores were similar between groups (p = 0.911). Relapse rates were higher in the own clinic group but did not reach statistical significance (p = 0.254). Multivariate analysis revealed that age was the only independent predictor of treatment success (odds ratio [OR] = 2.067, p = 0.019), while referral status was not an independent determinant. CONCLUSION:The modified Ponseti method provides effective midterm correction in complex clubfoot regardless of referral status. Although referred patients present later and may demonstrate worse functional outcomes, referral source does not independently influence treatment success. Early recognition and appropriate application of modified Ponseti principles remain critical for optimal outcomes.
OBJECTIVES:In this meta-analysis, we discuss the clinical efficacy of closed reduction with in situ fixation for valgus-impacted femoral neck fractures (VIFNFs) by contrasting postoperative functional recovery and complication profiles. MATERIALS AND METHODS:We performed a systematic literature search in PubMed, Embase, Web of Science, the Cochrane Library, and ScienceDirect for publications up to October 2025. The search targeted original studies which directly compared the surgical outcomes of closed reduction and in situ internal fixation for valgus-impacted femoral neck fractures. Search terms included combinations of: valgus-impacted (or valgus impaction), femoral neck fracture, in situ, reduction, and internal fixation. Pooled data were analyzed using mean differences (MD) with 95% confidence intervals (CIs) for continuous outcomes and risk differences (RD) with 95% CIs for dichotomous outcomes. RESULTS:The final analysis included a total of 447 patients extracted from five studies that met the predetermined inclusion criteria. The meta-analysis demonstrated that the closed reduction group exhibited a statistically significant reduction in postoperative femoral neck shortening (FNS) compared with the in situ fixation group (MD: 4.05; 95% CI: 2.68 ~ 5.42; p < 0.00001). For the caput-collum-diaphysis (CCD) angle, the closed reduction group showed a borderline significant improvement relative to the in situ fixation group (MD: 9.79; 95% CI: 0.19 ~ 19.39; p = 0.05). The in situ fixation group was associated with a substantially lower reoperation rate (RD: -0.08; 95% CI: -0.16 ~ -0.01; p = 0.04). No statistically significant intergroup differences were detected for the Harris Hip Score (HHS) (MD: -4.13; 95% CI: -9.37 ~ 1.11; p = 0.12), incidence of femoral head necrosis (RD: -0.05; 95% CI: -0.14 ~ 0.05; p = 0.36), or fixation failure rate (RD: -0.05; 95% CI: -0.17 ~ 0.06; p = 0.37). CONCLUSION:Closed reduction yields a statistically significant advantage in reducing postoperative FNS and a borderline significant benefit in maintaining the CCD. In contrast, in situ fixation is associated with a lower reoperation rate. The two strategies show comparable outcomes for the HHS, femoral head necrosis incidence, and fixation failure rate. Thus, surgical approach should be individualized based on patient-specific profiles.
OBJECTIVES:This study aims to evaluate the clinical and objective biomechanical outcomes at a minimum 10-year follow-up following open double-Tajima repair combined with a structured functional loading protocol. PATIENTS AND METHODS:Between January 2011 and December 2014, a total of 47 consecutive non-competitive adults (Tegner Activity Scale ≤ 4) with acute unilateral Achilles tendon rupture treated with open double-Tajima repair and an eight-week functional loading protocol were included in this retrospective cohort study. The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Secondary outcomes included isokinetic dynamometry (peak torque at 30°/s and total work at 120°/s for plantar flexion and dorsiflexion), joint position sense, and ankle/calf circumference. Between-limb comparisons were performed. RESULTS:Of the patients, 35 were male and 12 were female with a mean age at the time of surgery of 36.7 ± 6.6 (range, 22 to 55) years. The mean follow-up was 132.4 ± 13.5 (range, 120 to 168) months. The rupture involved the dominant limb in 29 patients (61.7%) and the non-dominant limb in 18 patients (38.3%). The primary outcome (AOFAS score) showed no statistically significant between-limb difference: the median score was 91.0 (IQR, 91.0 to 93.0) on the operated limb versus 93.0 (IQR, 91.0 to 93.0) on the contralateral limb (median difference: 0.00 points; 95% confidence interval [CI]: -1.00 to 1.00; p = 0.92). No statistically significant between-limb differences were detected across the secondary outcomes, including peak torque at 30°/s, total work at 120°/s, joint position sense, and ankle/calf circumference (p ≥ 0.09 for all). The complication rate was 4.3% (2/47): one partial rerupture managed conservatively and one superficial wound infection treated with oral antibiotics. No complete reruptures were observed. CONCLUSION:Open double-Tajima repair combined with a structured functional loading protocol seems to be associated with clinically acceptable long-term outcomes in this cohort of non-competitive adults. However, given the retrospective, single-cohort design without an independent comparison group or formal equivalence framework, these findings should be interpreted as descriptive long-term observations.
OBJECTIVES:This study aims to evaluate the effects of medial openwedge high tibial osteotomy (OWHTO) on gait analysis outcomes in patients with medial compartment osteoarthritis and varus alignment of the knee. PATIENTS AND METHODS:This prospective, observational study included a total of 22 patients who underwent biplanar medial OWHTO between February 2023 and March 2024 were included. Gait analysis was performed preoperatively and at the sixth postoperative month using the DIERS formetric 4D system. Early postoperative (6 months) gait parameters, angular parameters (tibial slope and correction angle), and joint kinematics were evaluated. Patient-reported outcomes were obtained using the Oxford Knee Score (OKS) to assess pain and physical function before and after the procedure. RESULTS:Of a total of 22 patients included in the study, 4 were male and 18 were female with a mean age of 55.41 ± 5.86 (range, 47 to 63) years. Postoperatively, patients' walking speed (0.83 ± 1.12 m/s), step length (0.58 ± 0.73 m), and cadence (82.72 ± 92.05 steps/min) increased significantly (p < 0.001). The tibial slope angle showed a mean increase of 1.93° (p < 0.001). The mean correction angle was 7.53°. The mean knee flexion increased significantly from 35.05° ± 8.74° preoperatively to 52.96° ± 13.21° postoperatively (p < 0.001). Knee extension improved minimally but significantly from -7.55° ± 1.18° to -6.03° ± 0.05° (p = 0.046). Ankle dorsiflexion increased significantly (p < 0.001), whereas changes in plantar flexion were not statistically significant. The OKS score increased significantly from 18.30 preoperatively to 41.50 at the sixth postoperative month (p < 0.001). CONCLUSION:Medial OWHTO results in early improvements in walking speed, step length, and cadence, as well as enhanced knee flexion kinematics and patient-reported outcomes. These findings indicate that OWHTO is an effective surgical option contributing to the improvement of gait patterns in the early postoperative period.
OBJECTIVES:This study aims to evaluate the reliability of cervical vertebral maturation (CVM) staging in determining skeletal maturity in patients with adolescent idiopathic scoliosis (AIS), focusing on the effect of professional experience among orthopedic surgeons. PATIENTS AND METHODS:Between January 2023 and January 2025, this reliability and agreement study included a total of 72 patients aged between nine and 16 years who were diagnosed with AIS. Intra- and inter-rater reliability were analyzed using weighted kappa (κ) statistics with standard errors (SEs) and 95% confidence intervals (CIs). A total of 72 full-spine lateral radiographs were independently assessed by 10 raters with varying levels of orthopedic expertise, including medical students, residents, consultants, and spinal surgeons. None of the raters had prior experience with the CVM classification. Each rater performed CVM staging twice with a four-week interval between assessments. RESULTS:Of the patients, 33 were male and 39 were female with a mean age of 13.07 ± 1.97 (range, 9 to 16) years. Overall intra-rater reliability was substantial (κ = 0.64, SE = 0.032, 95% CI: 0.569-0.714), and overall inter-rater reliability was moderate (κ = 0.52). Although spinal surgeons showed slightly higher intra-rater reliability overall, inter-rater reliability declined between assessments (first assessment κ = 0.61 vs. second assessment κ = 0.34). Consultants exhibited the highest inter-rater agreement (κ = 0.62), whereas residents showed improvement between assessments (κ = 0.40 vs. 0.52); however, no significant difference observed between groups. CONCLUSION:The reliability of CVM staging for assessing skeletal maturity in AIS patients does not significantly differ across levels of orthopedic expertise. While CVM staging has potential as a radiation-sparing method, the overall moderate agreement, particularly among physicians without prior experience, indicates that reliability is not significantly influenced by professional experience.
OBJECTIVES:This study aims to evaluate the demographic characteristics, anatomical distribution, diagnostic and treatment patterns, postoperative complications, recurrence rates, and recurrence-associated factors in patients diagnosed with tenosynovial giant cell tumors (TGCTs). PATIENTS AND METHODS:A total of 246 patients diagnosed with TGCT and treated between January 2010 and March 2021, were retrospectively analyzed. Pre- and postoperative data of the patients were recorded. Histopathological diagnosis was reviewed, and tumors were classified as localized TGCT and diffuse-type TGCT. Recurrence was defined as the reappearance of a lesion at the same location following an initially complete surgical excision. Survival time was defined as the time elapsed since surgery. Recurrence-free survival was calculated from the date of the surgical procedure to the date of recurrence or the last follow-up. RESULTS:Of a total of 246 patients included in the study, 87 were male and 159 were female with a mean age of 44.3 ± 16.3 (range, 18 to 75) years. The lesions were most commonly located in the hand (62.6%), predominantly at the phalangeal level (89.6%). Foot involvement was mainly at the ankle region (40.8%), while the knee was the third most frequently affected site (15%), with 64.8% of knee lesions being intra-articular. Multiple lesions were observed in 3.3% of patients. Small joints were involved in 63% of cases. Excisional biopsy was the most common diagnostic approach (63.8%), followed by Tru-Cut biopsy (23.2%) and incisional biopsy (8.5%), while macroscopically complete marginal resection was performed in 4.5% of cases. Postoperative complications occurred in 15.4% of patients, including infection, sensory deficits, hematoma, motion restriction, and vascular complications. The median follow-up was 43 months, and recurrence occurred in 15.4% of patients, of whom 76.3% required reoperation. CONCLUSION:Our study results suggest that TGCT is associated with a notable recurrence rate and postoperative morbidity. Accurate diagnosis, complete surgical excision, and long-term follow-up are essential for optimal management. Recurrence may be associated with factors such as pain at presentation, presence of multiple lesions, delayed treatment, and postoperative infection. Adequate surgical excision with sufficient margins is of utmost importance in reducing the risk of recurrence.
OBJECTIVES:This study aims to evaluate the mid-term clinical and functional outcomes of juxta-epiphyseal fractures of the proximal phalanx in pediatric patients. PATIENTS AND METHODS:Between July 2013 and December 2023, a total of 23 pediatric patients treated for juxta-epiphyseal fractures of the proximal phalanx were retrospectively analyzed. Functional outcomes were assessed using four subtests of the Jebsen-Taylor Hand Function Test. To compare the Jebsen-Taylor Hand Function Test, a control group of healthy children (n = 23) from the outpatient clinic was formed. Patients were treated either with closed reduction and splinting or with closed reduction followed by Kirschner wire (K-wire) fixation according to fracture displacement and stability. Radiographs were evaluated for residual deformity and malunion using Campbell's lines. RESULTS:Of a total of 23 patients, 13 were male and 10 were female with a mean age of 7.24 ± 2.21 (range, 6 to 13) years. The fifth digit was the most commonly affected (n = 14), followed by the fourth (n = 5), middle (n = 2), and thumb (n = 2). In 15 patients, the injury occurred on the non-dominant hand. No malunions were detected. One patient demonstrated a pseudo-claw deformity. Hand function tests revealed statistically significant delays in patients with dominant-hand injuries compared to healthy controls (p < 0.05). Seven patients reported a change in hand dominance after injury. CONCLUSION:Our study results suggest that appropriate reduction techniques, including closed or K-wire-assisted fixation, offer favorable outcomes with minimal complications. However, functional impairment can be more notable, when the dominant hand is involved. Taken together, these findings emphasize the need for early intervention, close follow-up, and consideration of hand dominance during recovery planning.
OBJECTIVES:This study aims to investigate the effect of a structured postoperative shoulder exercise program on shoulder range of motion (ROM) recovery and the development of postoperative shoulder stiffness following surgical fixation of distal radius fractures (DRFs). PATIENTS AND METHODS:This non-randomized, time-based cohort study included a total of 64 patients who underwent volar plate fixation of DRF between October 2022 and March 2023. Patients were allocated into two groups based on calendar periods and basic demographic factors were evaluated. Group 1 (exercise group, n = 33) was educated on pre-designed shoulder exercise to prevent shoulder stiffness after surgical treatment. Group 2 (control group, n = 31) was instructed to use their shoulders freely without an arm sling. Shoulder ROM and Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) scores were evaluated and compared at postoperative Weeks 2, 4, 8, 12, and 24. Shoulder stiffness was defined as passive ROM restricted by 30° or more compared to the contralateral side (or difference of two or more Constant-Murley scores in internal rotation) in two or more planes of movement. RESULTS:Of the patients, 12 were male and 52 were female with a mean age of 65.7 ± 8.9 (range, 42 to 85) years. The mean follow-up was 6.8 ± 1.6 months. Shoulder ROM markedly decreased between postoperative Weeks 2 and 4, but continuously improved until the final follow-up in both groups. A transient improvement in internal rotation at postoperative Weeks 4 and 8 was observed in Group 1 compared to Group 2. No significant difference in internal rotation was observed at the other time points. At the final follow-up, 7.8% of all patients continued to experience shoulder stiffness. CONCLUSION:Structured shoulder exercise may facilitate earlier recovery of shoulder internal rotation after volar plate fixation of DRFs. However, this advantage can be transient and cannot be maintained beyond eight weeks postoperatively, suggesting that shoulder ROM often recovers spontaneously even in the absence of a routine rehabilitation protocol. Furthermore, secondary shoulder stiffness following DRF fixation peaks at approximately four weeks after surgery and subsequently resolves more rapidly than the typical natural history of primary frozen shoulder. These findings indicate that structured shoulder exercises may provide short-term benefits in postoperative recovery, while the long-term clinical significance of routine shoulder rehabilitation remains uncertain.
OBJECTIVES:This study aims to investigate whether arthroscopy-assisted minimally invasive percutaneous plate osteosynthesis (MIPPO) provided more favorable early functional recovery and reduced surgical trauma compared to traditional open reduction and internal fixation (ORIF). PATIENTS AND METHODS:A total of 84 patients with Schatzker type I-IV tibial plateau fractures treated between January 2021 and January 2024 were retrospectively analyzed. The MIPPO group (n = 41) underwent arthroscopy-assisted reduction plus MIPPO, while the ORIF group (n = 43) received conventional ORIF. Allocation was chronological, with ORIF predominant in the first two years and MIPPO in the latter two years. Operative parameters, postoperative drainage, radiographic outcomes (Rasmussen radiological score), functional recovery (Hospital for Special Surgery [HSS] score), range of motion (ROM), fracture healing time, hospital stay, and complications were compared. RESULTS:Of a total of 84 patients, 28 were male and 56 were female of 49.4 ± 9.0 (range, 27 to 69) years. The arthroscopy-assisted MIPPO group had significantly longer operative time (96.0 ± 18.2 vs. 84.0 ± 13.9 min, p = 0.001) but shorter incision length (3.9 ± 0.7 vs. 6.2 ± 0.9 cm, p < 0.001), less intraoperative blood loss (56.5 ± 9.6 vs. 72.6 ± 10.1 mL, p < 0.001), and lower postoperative drainage volume (47.1 ± 7.5 vs. 59.0 ± 7.0 mL, p < 0.001) than the ORIF group. The arthroscopy-assisted MIPPO group also achieved higher Rasmussen radiological scores (15.4 ± 1.4 vs. 14.0 ± 1.6, p < 0.001) and better HSS scores at one, three, and six months postoperatively (all p < 0.001). At six months postoperatively, the MIPPO group also demonstrated significantly improved knee ROM (118.5° ± 8.2° vs. 107.3° ± 9.1°, p < 0.001), a difference exceeding the clinically meaningful threshold for activities of daily living. However, no significant differences were found in hospital stay (p = 0.051), fracture healing time (11.4 ± 1.3 vs. 11.1 ± 1.3 weeks, p = 0.340), or the excellent-and-good rate of HSS score at final follow-up (95.1% vs. 97.7%, p = 0.746). Complication rates were similar between the groups (p = 1.000). CONCLUSION:For Schatzker type I-IV tibial plateau fractures, arthroscopy-assisted MIPPO provides more favorable early functional recovery and radiological reduction quality compared to conventional ORIF, with less surgical trauma and comparable early functional recovery and similar complication rates during follow-up. Although operative time is longer, this minimally invasive approach is a safe and effective option for managing these complex fractures. Its principal advantage is accelerated early recovery, particularly in knee ROM, enabling patients to reach clinically meaningful thresholds for activities of daily living sooner.
OBJECTIVES:This study aims to evaluate the biomechanical effects of proximal fibular osteotomy (PFO) on tibiofemoral and proximal tibiofibular load transfer under simulated neutral and varus alignment conditions using a lower-extremity finite element analysis (FEA) model. MATERIALS AND METHODS:A patient-specific three-dimensional FEA model of the lower extremity was developed from computed tomography and magnetic resonance imaging data of a healthy volunteer. Neutral, 3° varus, and 5° varus alignments were simulated before and after PFO under a simplified physiological axial load of 900 N. Tibiofemoral compartment forces, proximal tibiofibular joint (PTFJ) force, distal tibiotalar reaction force, and peak von Mises stresses within the cartilage-meniscus complex were evaluated. RESULTS:Proximal fibular osteotomy markedly reduced PTFJ force across all alignment conditions. Under neutral alignment, PTFJ force decreased from 122.94 N to 21.84 N, while distal tibiotalar reaction force increased from 787.55 N to 897.89 N, indicating redistribution of load through distal pathways. Tibiofemoral compartment forces changed minimally. Under 5° varus alignment, medial tibiofemoral force decreased only from 608.45 N to 603.78 N following PFO. Peak medial meniscal and cartilage stresses increased with varus alignment and remained largely unchanged after osteotomy. CONCLUSION:In this single-subject static FEA model, PFO substantially reduced proximal tibiofibular loading, but produced only limited changes in tibiofemoral load distribution under simulated varus alignment. Within the present model, load redistribution occurred predominantly through distal load-transfer pathways rather than substantial unloading of the medial tibiofemoral compartment. These findings suggest that the biomechanical effect of PFO may primarily involve alteration of fibular load transmission rather than meaningful reduction of medial knee loading.
OBJECTIVES:This study aims to compare the efficacy of conventional rehabilitation alone, conventional rehabilitation combined with balance acupuncture (BA) and conventional rehabilitation plus BA and unconscious proprioception training in chronic ankle instability (CAI) patients. PATIENTS AND METHODS:This single-center, parallel-group, assessor-blinded randomized-controlled trial included a total of 120 CAI patients between October 2022 and October 2024. The patients were randomly assigned to control (n = 40), BA (n = 40), and combination therapy (CT, (n = 40) groups. All groups received six weeks of intervention (6 days/week): the control group received conventional rehabilitation, the BA group received conventional rehabilitation + BA and the CT group received conventional rehabilitation + BA + unconscious proprioception training. Unconscious proprioception training was defined as dual-task training using the MOTOmed system with cognitive distraction to shift focus away from conscious movement control. Assessments were conducted before and after treatment using a three-dimensional gait analysis system, a balance function testing and training system, and the Star Excursion Balance Test (SEBT). RESULTS:There was no statistically significant difference in age and sex among the groups (p > 0.05). In addition, disease duration and number of previous sprains were comparable among the groups (p > 0.05). Following the six-week intervention, all three groups showed significant improvements in gait parameters, balance function and SEBT scores compared to baseline (p < 0.05). The CT group exhibited significantly greater improvements in gait speed, cadence, movement length, movement ellipse area and SEBT scores than the BA group (p < 0.05), whereas the BA group outperformed the control group in all outcome measures (p < 0.05). No adverse reactions were reported in any group. CONCLUSION:The integration of BA and unconscious proprioception training may offer additional benefits for improving gait and balance in CAI patients compared to conventional rehabilitation plus BA or conventional rehabilitation alone. Based on these preliminary findings, the combined approach shows potential clinical value for targeted populations with CAI.
Tenosynovial giant cell tumor (TGCT) is a rare mesenchymal neoplasm arising from the synovium, tendon sheath, or bursa. Although the localized and diffuse forms of TGCT are typically considered benign, malignant TGCT characterized by marked histologic atypia and increased mitotic activity may exhibit aggressive clinical behavior. Pulmonary metastasis from malignant TGCT is rare and, in previously reported cases, pulmonary involvement has predominantly been described as parenchymal nodules or pleural lesions. In this article, we describe a rare case of endobronchial pulmonary metastasis occurring approximately 72 months after the initial diagnosis of malignant TGCT originating from the tendon sheath of the knee.
OBJECTIVES:This study aims to investigate the clinical effect of acupuncture combined with rehabilitation training in the treatment of knee osteoarthritis (KOA) under unified acupoint intervention. PATIENTS AND METHODS:In this prospective, comparative study informed by systematic acupoint analysis, the literature related to acupuncture for KOA treatment was retrieved from public databases and the core acupoints were analyzed using the Traditional Chinese Medicine Inheritance Calculation System (TCMICS) software. Eighty-four patients were selected as the participants, and the clinical effect (total efficacy rate), Numeric Rating Scale (NRS) for pain score, American Knee Society Score (AKSS) for knee joint function and the self-care ability score for daily living activities were used to evaluate the treatment effect. The curative effect index was calculated using the AKSS scores. RESULTS:After analyzing the core acupoints, we selected the Dubi, Zusanli, Yanglingquan, Xuehai, Neixiyan and Liang Qiu acupoints for the acupuncture treatment. The patients were divided into a control group (n = 42 patients undergoing rehabilitation training) and an intervention group (n = 42 patients undergoing acupuncture combined with rehabilitation training). The control group consisted of 15 male and 27 female, with a mean age of 62.90 ± 11.531 (range, 40 to 78) years. The mean course of the disease was 4.07 ± 1.841 years. The intervention group consisted of 16 male and 26 female, with a mean age of 63.95 ± 10.613 (range, 41 to 79) years and a mean disease course of 4.76 ± 2.328 years. There was no significant difference between the groups before treatment (p > 0.05). After acupuncture treatment, the 92.85% total efficacy rate (n = 39) was significantly higher than the 73.80% (n = 31) in the control group. The mean AKSS of the control and intervention groups were 64.17 ± 11.148 and 66.67 ± 17.795, respectively, and the mean knee joint articulation scores were 57.40 ± 8.925 and 54.10 ± 10.150 in the two groups, respectively. Following treatment, the scores of knee joint function and knee joint articulation in the intervention group were higher than those in the control group (p < 0.05). For AKSS, the mean difference of the control group was 6.030, and the proportion of patients who reached the improvement of minimum clinically significant difference (MCID) standard was 80.95%. The mean difference of the intervention group was 10.98, and the proportion of patients who reached MCID was 100%. Following treatment, the self-care ability score in the intervention group were higher than those in the control group (p < 0.05). For modified Barthel Index (MBI), the mean difference of the control group and intervention group were 6.446 and 6.225, all accounting for 100%. The mean NRS scores were significantly decreased from 5.19 ± 1.042 to 1.93 ± 0.640 after one month of acupuncture treatment. CONCLUSION:Our study results suggest that acupuncture combined with rehabilitation training based on data mining can relieve patients' pain, accelerate the recovery of their knee joint function and improve their daily living ability, demonstrating high clinical value in practice.
OBJECTIVES:This study aims to investigate the influence of implant design factors on mechanical behavior and to identify lower-profile biocomposite plate configurations with mechanical responses approaching those of a titanium reference construct under selected loading conditions. MATERIALS AND METHODS:In this computational finite element study, three-dimensional implant models were developed, and material properties of polyamide-6/nano-hydroxyapatite and titanium alloy (Ti6Al4V) were assigned. Seven composite plate types were modeled: flat (thicknesses 8, 9, and 10 mm), bellied, curved, enhanced, and hybrid plate. All constructs were mounted on a cylindrical synthetic femoral diaphyseal surrogate and fixed with six screws. Finite element analysis was conducted using ANSYS Mechanical 2022 R2 under axial compression (800 N), distraction (300 N), and torsion (10 Nm). Mechanical responses including maximum deformation, von Mises stress, and strain distribution in bone, plate, and screws were evaluated. Results were evaluated descriptively and comparatively across implant configurations and loading conditions. RESULTS:The titanium construct generally demonstrated the lowest deformation under torsional loading and the lowest plate strain response, whereas selected composite geometries approached or exceeded titanium-like deformation performance under specific loading modes. The hybrid plate showed the lowest deformation under compression, while the thick flat plate provided the lowest deformation among composites under distraction and torsion. The bellied design showed lower torsion-induced deformation and lower plate stress than most other lower-profile composite configurations. The enhanced plate exhibited the lowest plate strain among the composite models under compression and distraction but may pose challenges for soft tissue coverage due to its complex geometry. CONCLUSION:Optimizing plate geometry can substantially modify the mechanical behavior of biodegradable composite constructs. Hybrid and enhanced designs demonstrated load-mode specific mechanical responses that may inform future biodegradable plate optimization, particularly with further material refinement and experimental validation.
