BACKGROUND:Periacetabular osteotomy (PAO) is an established joint-preserving procedure for symptomatic acetabular dysplasia and other forms of acetabular malalignment. Although minimally invasive techniques have reduced surgical morbidity while maintaining correctional accuracy, the procedure remains technically demanding and relies heavily on intraoperative fluoroscopic guidance. Existing descriptions of minimally invasive PAO provide limited detail regarding the systematic use of fluoroscopy throughout the osteotomy sequence. This article describes a standardized fluoroscopy-guided technique for minimally invasive PAO. OPERATIVE TECHNIQUE:The procedure is performed through an 8-10 cm inguinal incision with preservation of key soft-tissue structures. A sequential series of fluoroscopically guided osteotomies of the superior pubic ramus, ischium, supra-acetabular region, and posterior column are performed using defined radiographic landmarks and checkpoints. Biplanar fluoroscopy is integrated throughout the procedure to confirm osteotome trajectory, osteotomy depth, fragment mobility, and final acetabular correction. Intraoperative assessment includes restoration of acetabular coverage, version, and inclination, with confirmation of lateral center-edge angle, Tönnis angle, anterior wall index, and posterior wall index. Technical pearls, pitfalls, and strategies to minimize neurovascular injury are highlighted. CONCLUSION:This standardized fluoroscopic protocol provides a reproducible framework for minimally invasive PAO. By integrating step-specific radiographic guidance with key anatomical landmarks, the technique aims to improve osteotomy control, optimize acetabular correction, and enhance procedural safety, particularly during the learning phase of this complex hip-preserving procedure.
OBJECTIVES:The predictive value of the global alignment and proportion (GAP) score in the Chinese geriatric population, which has unique demographic and degenerative characteristics, has not been validated. Given the high incidence of mechanical complications in this specific cohort, a dedicated mid-term evaluation is essential to guide surgical planning. To address this gap, this study aimed to analyze the accuracy and characteristics of the GAP assessment system in predicting mechanical complications following long-segment fixation surgery for geriatric patients with adult degenerative scoliosis (ADS) in a mid-term follow up period. METHODS:A retrospective analysis was conducted to select eligible ADS patients who had undergone long-segment fixation surgery at Xuanwu Hospital Capital Medical University between December 2016 and October 2020. Patients were divided into groups with mechanical complications (MC) and nonmechanical complications (NMC) for comparison. The GAP score and its classification were calculated based on the measurements. The association between GAP scores and mechanical complications was examined using logistic regression analysis. Additionally, the receiver operating characteristic curve (ROC) was utilized to evaluate the predictive performance of the GAP score for mechanical complications and to determine the threshold of the assessment system. RESULTS:A total of 133 ADS patients were included, with 65 in the MC group and 68 in the NMC group. The GAP score (area under the curve, AUC = 0.654) outperformed the GAP categories (AUC = 0.650) in predicting mechanical complications, and it was particularly accurate for proximal junctional kyphosis (PJK) (AUC = 0.872). However, both the GAP score (AUC = 0.201) and GAP categories (AUC = 0.181) demonstrated poor accuracy in predicting internal fixation breakage. CONCLUSION:The GAP score varied in its predictive performance and thresholds for different mechanical complications and internal fixation-related issues, exhibiting high accuracy for predicting PJK. However, it did not effectively indicate the risk of internal fixation breakage.
OBJECTIVE:Large annular defects after lumbar discectomy remain a major risk factor for recurrent herniation, particularly when the annular tear is located adjacent to the bony endplate, for which no well-established endoscopic repair strategy is currently available. To evaluate the feasibility and early clinical outcomes of a novel endoscopic annular-repair technique using an all-suture anchor implanted into the superior surface of the inferior vertebral endplate, performed entirely through unilateral biportal endoscopy (UBE), for closure of large annular defects near the endplate after lumbar discectomy. METHODS:We present a novel annular repair technique performed entirely under UBE using an all-suture anchor implanted into the superior surface of the inferior vertebral endplate, which is particularly suitable for lumbar disc herniation (LDH) cases involving downward migration of disc fragments. A monofilament shuttle is advanced across the annular tear, enabling passage of high-strength sutures that approximate the torn annulus to bone. We developed a bone-to-annulus repair method in which a monofilament shuttle is passed across the annular tear under direct UBE visualization to deliver high-strength braided sutures through the defect; these sutures are then secured to an all-suture anchor placed in the endplate, tension-tested, and the knot buried within the annulus. The technique was applied in a preliminary consecutive series of five patients presenting with 5-6 mm full-thickness annular defects discovered intraoperatively during UBE discectomy. Procedural time, intraoperative complications, and early clinical and radiographic outcomes were recorded, follow-up included one-month clinical assessment and imaging. RESULTS:The annular repair was technically feasible in all five cases, with the repair step adding a mean of 16 min to the standard discectomy. There were no intraoperative complications related to anchor placement or suture passage. All patients reported rapid relief of radicular symptoms and were mobilized early postoperatively. At one-month follow-up, clinical examination and imaging demonstrated intact annular repairs with no evidence of recurrent herniation or implant migration. CONCLUSION:The described UBE all-suture anchor technique enables direct bone-to-annulus fixation and safe closure of moderate (5-6 mm) full-thickness annular defects through standard endoscopic portals. Early results indicate technical feasibility, safety, and promising short-term clinical outcomes. Further biomechanical validation and longer-term, larger-cohort studies are required to determine its effectiveness in reducing recurrent LDH.
OBJECTIVES:The treatment of refractory skin and soft tissue defects (RSSTDs) has long posed a global challenge for surgeons. Traditional closure methods, such as skin grafting and flap repair, are often associated with significant trauma and a steep learning curve. Skin stretching, which enables the generation of "extra skin," has emerged as a promising alternative. This study aims to evaluate the efficacy of a disposable skin-stretch closure (DSSC) device combined with vacuum sealing drainage (VSD) in the treatment of RSSTDs. METHODS:A prospective single-arm clinical study was conducted to analyze the clinical data of 43 patients with RSSTDs who were treated with the DSSC device for wound repair at our hospital between July 2022 and December 2024. Among these patients, 30 were male and 13 were female, with ages ranging from 14 to 71 years (mean: 41.86 ± 16.02 years). The wound areas ranged from 4 to 90 cm2 (mean: 18.56 ± 18.04 cm2). Wound conditions (including closure and healing) and the presence of complications were recorded. Wound closure was defined as the approximation of wound edges by manually compressing the bilateral skin to achieve tension-free or minimal-tension coaptation, allowing direct suturing. Closure time and closure rate (wound area/closure time) were recorded. Wound healing was defined as 100% re-epithelialization of the wound surface, confirmed during two consecutive follow-up assessments spaced 2 weeks apart, with no exudate, drainage, or dressing requirements. Healing time and healing grade (classified as Grade A, B, or C according to wound healing classification standards) were recorded. RESULTS:All 43 patients were followed up, and all wounds achieved primary healing. No complications, including wound edge damage, necrosis, infection, dehiscence, or edema, were reported. Patients did not report pain or discomfort, and no significant scar formation was observed during the follow-up. The wound closure time ranged from 5 to 17 days (mean: 9.07 ± 2.93 days), which was comparable to the 7.8 ± 3.8 days reported in the literature. The wound closure rate ranged from 0.35 to 7.44 cm2/day (mean: 1.99 ± 1.63 cm2/day). The wound healing time ranged from 17 to 29 days (mean: 22.74 ± 2.80 days). The Visual Analog Scalescores ranged from 1 to 3 (mean: 2.02 ± 0.64), significantly lower than the 7.0 ± 1.0 reported in the literature. One patient experienced complete wound healing within 17 days without the need for suturing. CONCLUSION:The DSSC device was effective in treating RSSTDs, with short wound closure times, minimal complications, and a simple procedure.
Osteoarthritis (OA) is a prevalent, chronic degenerative joint disease characterized by progressive cartilage degeneration and impaired joint function. Its rising global incidence poses a significant health and socioeconomic burden. Traditional therapies primarily offer symptomatic relief but fail to halt disease progression and are associated with notable limitations. The contemporary understanding of OA pathogenesis has evolved from a model of mechanical wear to one emphasizing systemic imbalance within the joint microenvironment, involving immune dysregulation, metabolic disturbances, cellular senescence, and the gut-joint axis. This paradigm shift supports the development of innovative, disease-modifying strategies. This review is structured around a unifying multi-axis microenvironmental imbalance model for osteoarthritis. It systematically integrates the crosstalk and cascade-amplifying mechanisms of immune dysregulation, cellular senescence, metabolic disturbances, and the gut-joint axis, clarifying that multi-dimensional microenvironmental disruption collectively forms the pathological core of OA. We focus on how renewable biomaterials, engineered exosomes, and their composite systems target and regulate the pathological network to restore joint homeostasis, enabling a paradigm shift from symptomatic management to root-cause intervention. This work provides an integrated theoretical and translational roadmap for next-generation disease-modifying OA therapies.
INTRODUCTION:Distal femoral periprosthetic fractures following total knee arthroplasty (TKA) are complex and technically demanding injuries in orthopedic trauma surgery. With the increasing prevalence of TKA in an aging population, the incidence of these fractures has risen steadily. This study aims to share our experience of implant selection and surgical strategy, which provides an alternative and out-of-the-box thinking process for fracture fixation. METHODS:Between 2022 and 2024, 10 consecutive patients with distal femoral periprosthetic fractures involving a well-fixed femoral component were treated using a dual-plate construct incorporating a distal tibial metaphyseal locking plate for medial augmentation and distal femoral plate. Clinical, radiographic, and functional outcomes were retrospectively collected and analyzed. RESULTS:All patients were followed for a minimum of 12 months. Radiographic callus formation was observed at approximately 2 months postoperatively, and fracture union was achieved at a mean of 4 months. No cases of fixation failure, nonunion, or deep infection were observed during the follow-up period. Favorable functional outcomes were also noted at final follow-up. CONCLUSION:The use of a dual-plating construct that may provide enhanced mechanical stability was well established, allowing early mobilization and progression to weight-bearing. The distal tibial metaphyseal plate, which even though was not designed original for treating such kind of fracture, demonstrated good anatomical conformity to the medial distal femur and may serve as a practical option for medial augmentation. Orthopedic surgeons should not be constrained by the designation of a plate as an "anatomical plate"; rather, they should make judicious use of the implants available and apply them in the manner most appropriate for the specific fracture pattern. Using distal tibial metaphyseal plate as medial augmentation in dual-plate fixation appears to be a feasible and promising strategy for managing distal femoral periprosthetic fractures following TKA.
AIMS:Although total knee arthroplasty (TKA) remains the standard treatment for advanced knee osteoarthritis (OA), it often compromises joint proprioception and natural kinematics. Bicompartmental unicompartmental knee arthroplasty (bi-UKA), which preserves both the cruciate ligaments and patellofemoral joint, offers a joint-preserving alternative for selected patients with bicompartmental OA. This study aimed to compare the early- and mid-term outcomes of bi-UKA and TKA. METHODS:This single-center, prospective, real-world observational study included patients with knee osteoarthritis who were treated between January and October 2022. Eligible patients underwent either bi-UKA or TKA according to routine clinical decision-making and patient preference. Functional outcomes were assessed using the Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), timed up and go test (TUG), and 2-min walk test over a 2-year follow-up period. Preference-related selection bias was reduced using inverse probability of treatment weighting (IPTW) based on a five-item preoperative preference assessment tool, and longitudinal outcomes were analyzed using IPTW-weighted mixed-effects models. RESULTS:Eighty patients were included in this study (bi-UKA: n = 35, TKA: n = 45). After inverse probability of treatment weighting (IPTW) adjustment, the bi-UKA group showed more favorable early outcomes: higher 1-month KSS functional scores (p = 0.001); better WOMAC scores at 1, 6, and 12 months (p < 0.05); greater ROM throughout follow-up (p < 0.0001); shorter TUG times; and longer 2MWT distances at early time points. The Forgotten Joint Score (FJS) scores at 1 and 2 years also favored bi-UKA, indicating greater satisfaction. CONCLUSION:Bi-UKA was associated with more favorable early functional recovery. By preserving the key anatomical structures and enabling more physiological motion, bi-UKA may be a feasible alternative in selected patients.
OBJECTIVE:Depth-gauge measurements can be time-consuming and prone to technical error. The aim of this study is to evaluate whether "anatomic zones" along the distal femur can be used to help estimate distal interlocking screw length during femoral intramedullary nailing. METHODS:A retrospective "anatomical control" cohort was used to establish anatomic zones along the length of the distal femur and estimated screw length within each zone. Estimated screw lengths for each zone were based on mean cortex-to-cortex length at each zone as measured on computed tomography (CT). A validation cohort was prospectively enrolled to evaluate agreement between these estimated screw lengths and depth-gauge measurements for each zone. Agreement was evaluated using mean differences between estimated screw lengths and depth-gauge measurements, an intraclass correlation coefficient (ICC), and Bland-Altman analysis. RESULTS:The retrospective cohort of 56 patients was used to establish eight anatomic zones. Screw length estimates derived from CT-based measurements ranged between 42.1 mm in the most proximal zone to 80.2 mm in the most distal zone. The validation cohort included 74 patients (126 screws), was 63.51% male (n = 47), with mean age 44.2 ± 24.7 years, mean height 173.2 ± 12.7 cm, and mean BMI 28.5 ± 10 kg/m2. The mean absolute value difference between zone-estimated screw lengths and depth-gauge measurements was 3.9 mm ±2.9 mm, ranging 2.7 mm-5.6 mm depending on zone. The ICC was 0.94 (95% CI [0.91, 0.96], p < 0.01). Bland-Altman analysis revealed a bias of -0.86 mm with limits of agreement at +8.6 mm and -10.3 mm. CONCLUSION:Anatomic zone-based screw length estimates derived from CT data show strong agreement with depth-gauge measurements and are a potential adjunctive strategy to reduce operative time and errors in screw length selection without the need for additional equipment or technology.
ABSTRACT Objectives Hip arthroscopy–assisted surgery has been proposed as a minimally invasive option for femoral head fractures; however, evidence with mid‐term follow‐up remains limited. This study aimed to evaluate the clinical and radiographic outcomes of arthroscopy‐assisted management for Pipkin Types I and II femoral head fracture–dislocations with a minimum follow‐up of 5 years. Methods This retrospective study included 23 consecutive adults (19 Pipkin I and 4 Pipkin II) treated with hip arthroscopy–assisted fragment excision or internal fixation between March 2013 and January 2020. Preoperative computed tomography was used for surgical planning, and fixation was placed with arthroscopic headless screws. Clinical outcomes were assessed using the Harris Hip Score (HHS) and Thompson–Epstein (T–E) criteria. Radiographic evaluation included avascular necrosis (AVN), heterotopic ossification (HO; Brooker), osteoarthritis (OA; Tönnis), and fracture reduction quality (Matta's criteria). Group comparisons were evaluated using independent samples t‐tests, Mann–Whitney U tests, and Fisher's exact test. The mean follow‐up was 86.2 ± 21.2 months. Results The cohort consisted of 19 males and 4 females with a mean age of 28.7 ± 9.9 years. Fifteen patients underwent fixation and eight underwent excision. The final mean HHS was 98.3 ± 1.9, with 21 patients (91%) achieving excellent and 2 (9%) good T–E criteria. There were no significant differences between the fixation and excision groups in demographic characteristics, operative time, or functional outcomes (all p > 0.05); however, hospital stay was significantly shorter in the excision group (2.9 ± 0.6 vs. 5.5 ± 4.6 days, p = 0.028). In the fixation group, mean maximal displacement improved from 7.6 mm preoperatively to 2.6 mm postoperatively, with anatomic reduction achieved in 6 cases (40%), imperfect in 6 (40%), and poor in 3 (20%). Patients with Pipkin Type I fractures had significantly higher HHS than those with Type II fractures (98.7 ± 1.7 vs. 96.0 ± 0.8, p = 0.018). Complications were rare, with one case of Brooker Grade I HO and one case of mild OA. No AVN or total hip arthroplasty occurred during the follow‐up. Conclusions Hip arthroscopy–assisted management of selected Pipkin Type I and II femoral head fractures yields excellent mid‐term clinical outcomes with acceptable radiographic reduction and a low complication rate. This minimally invasive technique represents a viable alternative in appropriately selected patients when fragment characteristics and surgical expertise permit.
ABSTRACT Background The morphology of fractures in the terrible triad of the elbow (TTE) is complex, and precise management relies on a profound understanding of this morphology. This study aims to systematically analyze, for the first time, the distribution and morphological characteristics of TTE fracture lines using three‐dimensional (3D) imaging technology. Methods Clinical data and thin‐slice CT scans of 112 patients with TTE from January 2021 to December 2024 were retrospectively included. 3D fracture models were reconstructed using Mimics software. Virtual reduction and standardized alignment were performed using 3‐matic software. Fracture lines were mapped onto standard ulnar and radial templates, and 3D fracture heat maps were generated using the E‐3D software to demonstrate the high‐frequency distribution zones of the fracture lines visually. Statistical analysis was performed using SPSS software (version 21.0, IBM Corp., Armonk, NY, USA). Continuous variables were compared using one‐way analysis of variance (ANOVA), and categorical variables were compared using the chi‐square test (χ2 test). A two‐tailed p < 0.05 was considered statistically significant. Results The study revealed distinct patterns in the distribution of TTE fracture lines. In the coronoid process, the fracture “hot zone” presented as an annular high‐density band extending from the lateral middle aspect to the tip. In the radial head, an oblique high‐density band was observed in the anterolateral quadrant of the articular surface. The radial neck exhibited a circumferential high‐density zone, which was most prominent in the anterolateral aspect. Statistical analysis indicated a significant correlation between age and fracture complexity; the proportion of Regan–Morrey type III coronoid fractures and Mason type III radial head fractures was significantly higher in elderly patients (> 60 years) (p < 0.05), suggesting that advanced age is a significant risk factor for complex fractures. Conclusion This study is the first to visually reveal the Collaborative Distribution Patterns of TTE fracture lines using 3D fracture mapping technology. This model provides morphological evidence for understanding the injury mechanism of TTE and offers an anatomical framework that may assist surgeons in individualizing surgical approaches and fixation strategies.
OBJECTIVE:Concomitant injury of the posterolateral corner (PLC) and the proximal tibiofibular joint (PTFJ) is a complex clinical entity that currently lacks a standardized surgical treatment. Failure to address PTFJ instability can compromise the result of PLC reconstructions. Therefore, the purpose of this study is to describe a surgical technique for simultaneous stabilization of the PLC and the PTFJ in the setting of a combined injury. METHODS:An anatomic ligament reconstruction of the PLC and PTFJ was performed on a cadaveric knee specimen using two tendon autografts. Tunnel placement and graft passage were guided by anatomical landmarks. A sequential fixation strategy was implemented, allowing independent graft tensioning and fixation at predetermined knee flexion angles. Qualitative knee stability was assessed comparatively before and after reconstruction using standard examination maneuvers. RESULTS:The described technique allowed an anatomic reconstruction of both the PLC and the PTFJ. Reconstruction of the proximal tibiofibular ligaments provided a stable structural base at the fibular head, enhancing the reliability of the PLC reconstruction. Independent graft fixation enabled controlled tensioning consistent with known biomechanical principles. CONCLUSIONS:This technical note describes an anatomic technique for combined PLC and PTFJ stabilization in a complex injury pattern for which no standardized surgical solution has been defined in the literature. This technique may serve as a foundation for future biomechanical and clinical studies.
ABSTRACT Background Early rehabilitation programs are often considered essential for optimizing patient recovery after total knee replacement. Popliteal artery pseudoaneurysm, an infrequent but recognized risk during total knee replacement associated with early postoperative rehabilitation, is relatively rare. Case Presentation We report a case of severe knee inversion deformity in a 56‐year‐old male patient with traumatic arthritis of the right knee. The man complained that the pain has gradually worsened over the past year. The patient underwent right knee replacement surgery at our hospital, using the Legacy Constrained Condylar Knee (LCCK) prosthesis. On the fourth day after the operation, the patient suddenly experienced tearing pain during the flexion movement of the knee joint. Immediate pain relief and other symptomatic treatments were administered, and vascular CT angiography (CTA) revealed a popliteal artery pseudoaneurysm. Subsequently, vascular surgery was performed to explore and surgically remove the pseudoaneurysm. The patient's postoperative symptoms had improved, and after 1 month of follow‐up, joint activity was good. Conclusions This case emphasizes the importance of cautious postoperative rehabilitation methods for patients with severe knee joint deformities undergoing total knee replacement surgery, in order to balance the benefits of early activity and potential complications, ultimately improving patient safety and outcomes during rehabilitation.
BACKGROUND:Osteoporosis is a common chronic skeletal disorder characterized by decreased bone mass and microarchitectural deterioration, resulting in increased fragility and fracture risk. With rapid population aging in China, the prevalence of osteoporosis is rising, while public awareness and engagement in prevention remain insufficient. Existing national guidelines mainly target healthcare professionals and lack accessible, evidence-based recommendations for the general public. This guideline aims to provide practical guidance for osteoporosis risk assessment and prevention at the population level. METHODS:The guideline was developed by the Chinese Health Risk Management Collaboration-Osteoporosis Group in accordance with the WHO Handbook for Guideline Development, the Principles for Developing or Revising Clinical Practice Guidelines in China (2022), and AGREE II and RIGHT frameworks. Evidence from both English and Chinese databases was synthesized and graded using the GRADE approach. Fourteen key questions were formulated through a modified Delphi consensus process. RESULTS:A total of 15 recommendations were developed, covering osteoporosis risk screening (OSTA, IOF One-Minute Test, FRAX), dietary and nutritional strategies (protein, dairy, calcium, vitamin D, fruits and vegetables), lifestyle interventions (exercise, bodyweight control, sunlight exposure, smoking cessation, alcohol reduction, tea drinking), and fracture prevention in patients with osteoporosis. CONCLUSION:This guideline provides practical, evidence-based strategies to improve public awareness and promote risk management of osteoporosis among the general population, potentially reducing fracture incidence and public health burden.
OBJECTIVE:We previously developed a novel internal tension-relieving augmentation suture, the Chinese knotting technique (CKT), which demonstrated better knee kinematic recovery and clinical outcomes when assisting posterior cruciate ligament (PCL) reconstruction. This study evaluated the biomechanical effect of the CKT in cadaveric PCL reconstruction and provided experimental evidence for its clinical application. METHODS:Ten fresh-frozen adult knee joint specimens were randomly divided into the conventional reconstruction (CR; n = 5) and CKT (n = 5) groups. First, all native PCLs underwent cyclic fatigue testing with a standardized fixation method, and the relaxation length was recorded. The native PCL was then transected and reconstructed. After reconstruction, the same fixation method was applied for biomechanical testing to measure stiffness, elastic modulus, maximum load, and relaxation length. RESULTS:No statistically significant differences were observed between the two groups in donor age (54.40 ± 5.94 years vs 56.60 ± 5.98 years), gender distribution (male: 80.00% vs. 60.00%), or specimen side (left: 60.00% vs. 40.00%) (p > 0.05). All specimens underwent successful reconstruction and testing with no instances of tissue damage or fixation abnormalities. The biomechanical testing revealed no statistically significant differences in stiffness (68.60 ± 8.62 N/mm vs. 65.40 ± 12.14 N/mm) or elastic modulus (147.60 ± 5.68 MPa vs. 142.60 ± 1.52 MPa) between the two groups (p > 0.05). However, the CKT group demonstrated a significantly higher maximum load (603.20 ± 77.44 N) compared with the CR group (442.20 ± 20.52 N) and a significantly lower relaxation length (1.50 ± 0.09 mm vs. 2.46 ± 0.02 mm) (p < 0.05). CONCLUSION:The CKT preserved the basic mechanical properties of the graft in PCL reconstruction. This technique significantly increased the maximum load and reduced residual deformation after cyclic loading, thereby providing enhanced biomechanical protection for the graft. This approach may offer technical support for early postoperative rehabilitation and a reduced risk of graft failure.
ABSTRACT Background Although C2 pedicle screws are considered the gold standard for atlantoaxial fixation, the optimal fixation strategy for patients with high‐riding vertebral arteries (HRVA) or narrow C2 pedicles (NC2P) remains controversial because of the increased risk of vertebral artery injury and the limitations of alternative fixation techniques. Objective To evaluate the safety, stability, and clinical efficacy of an individualized C2 screw fixation strategy incorporating vertebral artery mobilization for complex upper cervical anatomy. Methods A retrospective study was conducted in 312 patients who underwent C2 fixation between 2017 and 2025. Patients were categorized according to fusion method, screw laterality, and VA transposition requirement. Bone fusion rates and screw accuracy (Gertzbein–Robbins grading) were compared across groups using χ2, Fisher's exact, and multivariate logistic regression analyses to control confounders. Results All procedures were successfully completed without permanent neurovascular injury. At 6 months, the fusion rate with an atlantoaxial fusion cage was significantly higher than with interlaminar bone grafting (92.3% vs. 51.0%, p < 0.001). Unilateral C2 pedicle screw fixation combined with a contralateral alternative screw achieved comparable stability to bilateral fixation (p > 0.05). Screw placement accuracy was 100% clinically acceptable in normal anatomy and 60% in cases requiring VA mobilization, with no VA injury or blood flow compromise. Conclusion The proposed multi‐strategy C2 screw placement protocol—integrating fusion cage support and VA mobilization—achieves superior fusion, reliable fixation, and high safety, even in anatomically challenging conditions. This approach provides a reproducible and versatile solution for C2 instrumentation in complex craniovertebral junction surgery.
ABSTRACT Objective Although traumatic brain injury (TBI) has been clinically associated with accelerated bone healing, the factors that determine which patients experience this phenomenon remain poorly defined, and previous findings are conflicting. This study aimed to investigate the clinical factors associated with accelerated fracture healing in patients with TBI combined with comminuted fractures of the limbs, so as to provide an evidence‐based foundation for elucidating the clinical phenomenon of TBI‐promoted fracture healing. Methods A retrospective case–control study design was employed. Patients between January 2020 and April 2024 with concurrent diagnoses of TBI and comminuted fractures were included. Based on radiographic findings and RUST/mRUST scores, patients were divided into an accelerated healing group (AHG) and a normal/delayed healing group (NDHG). Clinical data including demographics (age, sex, BMI), TBI characteristics (injury site, GCS score), admission laboratory indices (blood count, coagulation function, inflammatory markers), and fracture site/local soft tissue conditions, as well as functional outcomes assessed by the Short Musculoskeletal Function Assessment (SMFA) questionnaire at final follow‐up were collected. Univariate analysis and multivariate logistic regression analysis were used to identify independent factors influencing accelerated fracture healing. Receiver operating characteristic (ROC) curves were plotted to evaluate their predictive value. Results A total of 119 patients were included, with 69 in the AHG and 50 in the NDHG. Significant differences were observed between the two groups in terms of age, BMI, GCS score, and platelet count (p < 0.05). Univariate analysis showed that age, BMI, GCS score, red blood cell count, and platelet count were associated with accelerated fracture healing (p < 0.20). Multivariate logistic regression analysis indicated that younger age (OR = 0.875, 95% CI: 0.821–0.934) and lower GCS score (indicating more severe TBI; OR = 0.490, 95% CI: 0.339–0.707) were independent predictors of accelerated fracture healing. ROC curve analysis showed that the area under the curve (AUC) for age and GCS score in predicting accelerated healing were 0.893 and 0.851, respectively. Conclusions In patients with TBI combined with comminuted fractures, younger age and greater TBI severity (lower GCS score) are independent predictors of accelerated fracture healing. These findings assist clinicians in the early identification of patients with high healing potential to optimize treatment strategies, facilitate the early identification of high‐risk patients, and provide clinical clues for further exploration of the molecular mechanisms underlying neurohumoral regulation of bone regeneration.
ABSTRACT Background Uniportal non‐coaxial spinal endoscopic surgery (UNSES) via far‐lateral approach (FLA) is an innovative minimally invasive procedure for lumbar degenerative diseases, particularly far‐lateral disc herniation and foraminal stenosis. However, complex lateral lumbar anatomy and strict endoscope‐instrument coordination create a distinct learning curve that may compromise early surgical efficiency and safety. This study aimed to evaluate the efficacy and safety, quantify the learning curve, and to provide clinical guidance for the standardized promotion and application of this technology. Methods A total of 40 consecutive patients with lumbar degenerative diseases who underwent UNSES via FLA by a single surgeon between January 2025 and December 2025 were included. All data were analyzed using SPSS 26.0 statistical software (IBM, USA). Primary outcomes included operation time, blood loss, fluoroscopy frequency, and intraoperative complication rate. Secondary outcomes were VAS, ODI, and modified Macnab criteria at 1, 3, and 6 months postoperatively. The learning curve and the inflection point of the learning curve was determined using cumulative sum (CUSUM) analysis. The differences in clinical indicators between early and proficient stage were compared. Result Operation time, blood loss, and fluoroscopy times decreased significantly with case accumulation (p < 0.05). CUSUM identified an inflection point at the 16th case, after which operation time stabilized at (55.3 ± 8.6) min, much shorter than the early phase (89.5 ± 10.3) min (p < 0.001). Before the 16th case, the curve was in an upward trend; after the 16th case, the curve tended to be flat, indicating the proficiency stage. Postoperative VAS and ODI improved significantly than those before surgery at each follow‐up time (p < 0.05). There was no significant difference in postoperative VAS score and ODI between the two groups at each follow‐up time point (p > 0.05). The total complication rate was 12.5% (5/40), were cured by conservative treatment. The total excellent‐good rate was 90.0% (36/40). L5/S1 and Bertolotti's syndrome were independent factors affecting the learning curve. Conclusion UNSES via FLA is a safe and effective minimally invasive technique for treating complex lumbar degenerative diseases. It has a certain learning curve, and the inflection point is about the 16th case. After mastering the key techniques such as anatomical positioning, endoscopic manipulation and hemostasis, the surgeon can gradually reach the proficiency stage, with significantly improved surgical efficiency and clinical efficacy, and controllable complications. This study provides a theoretical basis for the clinical training and technology promotion of UNSES via FLA.
ABSTRACT Background Delayed postoperative spinal epidural hematoma (DPSEH) is a rare but serious complication of cervical open‐door laminoplasty, which occurs more than 3 days after the procedure. Although multi‐level surgery, coagulopathy, and hypertension are known risk factors, suture‐related mechanisms have rarely been identified as the main cause. Case Presentation We present two cases of symptomatic DPSEH occurring on the seventh postoperative day following posterior cervical open‐door laminoplasty. Following initial recovery, both patients experienced acute neurological deterioration. An emergency MRI revealed hematomas within the paraspinal muscles compressing the spinal cord. Intraoperative exploration identified a huge hematoma within the posterior cervical muscles and active bleeding from muscle tissue, with no injury to the epidural venous plexus. Interestingly, absorbable barbed sutures were used for muscular and fascial closure in both procedures. The patients exhibited significant neurological recovery following emergency hematoma evacuation. Conclusion These cases suggest that suture‐related complications, specifically knot loosening, suture migration, or barb‐induced tissue cutting, may contribute to intramuscular bleeding and subsequent DPSEH. However, given the limited evidence from a two‐case report, this association should be interpreted as a clinical alert rather than definitive proof of causality. Surgeons should maintain a high index of suspicion for DPSEH in patients who experience sudden postoperative pain or neurological decline. They should also consider suture choice as a potentially modifiable risk factor.
OBJECTIVE:Adhesive capsulitis (AC) is characterized by progressive fibrosis of the glenohumeral capsule, with the rotator interval (RI) as a key pathological site. Ultrasound-guided hydrodilation of the RI (Yoong technique) is an established intervention, but traversal of a thickened coracohumeral ligament (CHL) can be technically challenging and painful. This study reports preliminary 2-year outcomes of a modified technique targeting the subacromial-subdeltoid (SASD) bursa at the RI, combined with immediate postinjection manipulation. METHODS:A retrospective case series was conducted on 13 patients with AC in the frozen phase treated between January 2023 and September 2023 at a single sports medicine clinic. The modified technique involved ultrasound-guided SASD bursa injection (20 mL mixture: 4 mL 1% lidocaine, 15 mL 5% dextrose, 1 mL triamcinolone acetonide 40 mg) with mechanical fenestration of the CHL, followed by immediate shoulder manipulation. Outcomes included forward flexion, abduction, external rotation, Visual Analog Scale (VAS), and Quick DASH scores measured at baseline, 2, 12, 24, 52, and 104 weeks. RESULTS:Mean age was 51.9 years (SD 7.52); 92.3% were female; 53.8% had diabetes. Significant improvements were observed across all outcomes (p < 0.001). Forward flexion improved from 76.6° (SD 6.3°) at baseline to 178.6° (SD 3.7°) at 104 weeks; abduction from 60.6° (SD 6.3°) to 178.8° (SD 2.7°); external rotation from 31.3° (SD 9.1°) to 78.0° (SD 3.6°). VAS decreased from 5.6 (SD 0.9) to 0 at 52 and 104 weeks. Quick DASH improved from 86.7 (SD 5.8) to 0.2 (SD 0.7) at 104 weeks. No complications were reported. CONCLUSION:This modified SASD-targeted injection technique, combined with immediate manipulation, was associated with sustained pain relief and functional improvement over 2 years in a small cohort of AC patients.
ABSTRACT Background Current clinical strategies emphasize delaying total hip arthroplasty (THA) in patients with nontraumatic osteonecrosis of the femoral head (NONFH). However, it remains unknown whether prolonged abnormal joint mechanics during this delayed period compromise the final surgical outcomes. Consequently, the impact of the prolonged collapsed or non‐collapsed hip joint stages on THA efficacy has not yet been evaluated. This study aimed to analyze the effect of the duration of a collapsed or non‐collapsed hip joint on the efficacy of subsequent THA. Methods This retrospective cohort study included 111 NONFH patients who underwent primary unilateral THA between June 2022 and June 2023. Patients were grouped based on the duration of their non‐collapsed or collapsed stages (≤ 1 year, 1–3 years, and > 3 years) prior to surgery. Postoperative outcome measures, including the numerical rating scale (NRS) for pain and the Harris Hip Score (HHS) for hip function, were obtained through video‐call follow‐up. Statistical analyses included ANOVA, Kruskal‐Wallis H tests, multivariable GLM, and ROC curve analysis. Results A total of 111 patients were ultimately included in this study. Significant differences were found between the Joint Surface Non‐Collapse Group and the Survival with Collapse Group regarding whether they had received oral medication treatment (p < 0.05). Patients with different survival durations of collapse demonstrated significant differences in ARCO staging at the time of final THA (p < 0.05). Postoperatively, significant differences in NRS scores were observed among patients with different survival durations of collapse (p < 0.05), with the 1–3 year collapse group reporting higher pain scores compared to the > 3 year group. However, multivariable GLM revealed that preoperative duration did not independently predict the final absolute HHS (p > 0.05), indicating an equalizing trend of THA across all groups. Notably, the duration of collapse independently predicted postoperative pain, with the 1–3 year group exhibiting significantly worse NRS scores (p = 0.023). Conclusion While THA provides highly effective and equalized functional recovery regardless of the preoperative duration of the collapsed or non‐collapsed stages, surgical timing significantly impacts postoperative pain. Operating during the 1–3 year post‐collapse window is an independent risk factor for inferior pain relief. Given the limited subgroup sizes, these exploratory findings warrant further multicenter validation. Level of Evidence Level III.
