Abstract Background: Humeral shaft fractures are frequently treated with intramedullary nailing (IMN), yet nonunion remains a significant complication. Although clinical predictors of nonunion have been described, radiographic factors such as fracture morphology and interfragmentary gap are less consistently reported. Objectives: This study aimed to evaluate clinical and radiographic predictors of nonunion after IMN for humeral shaft fractures, with particular focus on the interaction between fracture classification and interfragmentary gap. Materials and Methods: We retrospectively reviewed 132 patients treated with IMN for acute humeral shaft fractures between 2018 and 2024. All patients had at least 12 months of follow-up. Demographic, surgical, and radiographic variables were analyzed. Fractures were classified according to AO/OTA Fracture and Dislocation Classification (AO/OTA) criteria, with interfragmentary gap and alignment measured on standardized postoperative radiographs. Nonunion was defined as the absence of union at 6 months. Univariable and multivariable logistic regression were performed, and receiver-operating characteristic (ROC) analysis identified optimal gap cutoffs. Results: Among 132 patients, 120 (90.9%) achieved union and 12 (9.1%) developed nonunion. Wedge fractures (Type B) had significantly higher nonunion rates than simple fractures (18.2% vs. 6.1%, P = 0.037). Larger gaps increased nonunion risk, with wedge fractures and gap >2 mm showing the highest rate (20.0%, P = 0.028). In multivariable analysis, wedge fractures with a gap >2 mm were independently associated with nonunion (adjusted odds ratio [OR] 9.46, 95% confidence interval [CI] 1.02–87.63, P = 0.048). Alignment showed a borderline association (OR 1.19 per degree, 95% CI 0.995–1.418, P = 0.057). ROC analysis yielded an area under the curve of 0.662; the optimal cutoff was >3.3 mm (Youden’s Index 0.297), but >2 mm was considered the most clinically relevant threshold. Conclusions: Nonunion after IMN in humeral shaft fractures is associated with both fracture morphology and interfragmentary gap. Wedge fractures combined with a gap >2 mm significantly increase nonunion risk, highlighting the importance of minimizing fracture gap during fixation.
Abstract Background: Osteosarcoma is the most common primary malignant bone tumor, predominantly affecting the femur, tibia, and humerus. Despite advances in surgical oncology, comprehensive evaluations of biological reconstruction methods remain limited, with existing literature primarily consisting of small retrospective cohort studies. Objectives: This systematic review aimed to assess the outcomes and prognostic factors associated with allograft and recycled autograft reconstruction techniques following tumor resection. Materials and Methods: Six studies comprising 368 patients were included after a systematic search of PubMed, Embase, and Scopus. Pooled descriptive statistics were used to assess time to bone union and postoperative complications. Separate meta-analyses were conducted for each outcome. Results: Among the patients, 160 (43.5%) underwent allograft reconstruction and 208 (56.5%) received recycled autografts. Allograft reconstruction showed a trend toward shorter time to union (9.01 vs. 11.23 months; mean difference (MD): −0.92 months [−1.89, 0.05]; P = 0.06), though not statistically significant. There were no significant differences in rates of nonunion (risk ratio [RR]: 0.99), fracture (RR: 1.00), soft tissue failure (RR: 0.42), infection (RR: 1.52), or recurrence (RR: 1.10). Conclusions: Although both allograft and recycled autograft reconstructions demonstrated comparable effectiveness in terms of union time and postoperative complications, our analysis revealed a trend toward shorter time to union in the allograft group compared with the recycled autograft group, without reaching statistical significance. Therefore, the current evidence suggests that both reconstruction methods are viable options following wide resection of osteosarcoma.
Abstract Chondroblastoma is a rare benign bone tumor of cartilaginous origin, and its occurrence in the femoral head is particularly uncommon. We report the case of a 20-year-old female who presented with progressive left hip pain, with imaging revealing a well-defined, lobulated osteolytic lesion extending from the femoral head to the proximal neck. She underwent intralesional curettage via the direct anterior approach (DAA), combined with adjuvant cryotherapy, bone grafting, and internal fixation using the femoral neck system – all performed without hip dislocation. Histopathological analysis confirmed chondroblastoma, and the postoperative course was uneventful. At follow-up, the patient regained full, pain-free hip motion without evidence of recurrence, avascular necrosis, or hardware-related complications. This case demonstrates that a joint-preserving DAA approach can achieve excellent oncologic control and functional outcomes in femoral head chondroblastoma.
Abstract Background: Inferior pole patellar fractures are challenging to treat due to fragment comminution and high extensor mechanism forces, which complicate both reduction and maintenance of fixation. While traditional methods such as tension band wiring (TBW) and suture repair (SR) are commonly used, novel techniques such as vertical cerclage wiring (VCW) have been introduced to improve fixation strength and facilitate early rehabilitation. However, comparative studies evaluating early postoperative alignment among these methods are lacking. Objectives: This study aimed to compare early postoperative alignment outcomes among three fixation techniques – VCW, TBW, and SR – for inferior pole patellar fractures, using a novel radiographic measurement method. Materials and Methods: A retrospective review was conducted of 36 patients with AO/OTA 34 A1 extra-articular inferior pole patellar fractures treated between April 2016 and May 2025. Patients were grouped by fixation method: VCW ( n = 7), TBW ( n = 14), and SR ( n = 15). Postoperative alignment was assessed on lateral radiographs using three parameters: residual gap, fracture apposition, and angulation. Statistical analysis included the Kruskal–Wallis test and post hoc Dunn’s test. Results: There were no significant differences in demographic or preoperative fracture characteristics among the three groups. The VCW group showed a significantly smaller residual gap compared to the SR group and significantly less fracture angulation than both the TBW and SR groups. No significant differences in fracture apposition were observed among the groups. Conclusions: VCW provides superior early postoperative alignment in inferior pole patellar fractures, with significantly less residual gap and angulation compared to TBW and SR. These findings support VCW as a biomechanically favorable option for comminuted inferior pole patellar fractures, although further studies with larger cohorts and longer follow-up are warranted to assess long-term outcomes.
Abstract Background: Perioperative implant-associated fractures (PIAFs) are defined as new cortical or structural disruptions occurring during nail insertion and represent an under-recognized complication associated with cephalomedullary nailing in geriatric pertrochanteric fractures. Objectives: This study aimed to evaluate the incidence, associated factors, and radiographic characteristics of PIAFs in a consecutive cohort. Materials and Methods: A retrospective review was conducted on 258 patients aged ≥60 years who underwent fixation with either proximal femoral nail antirotation II™ or INTERTAN™ devices between 2019 and 2022. Demographic variables, proximal femoral morphology, reduction quality, fixation parameters, and early postoperative radiographs were analyzed. Results: PIAFs occurred in 17 patients (6.6%). In univariate analysis, patients with PIAFs had higher body mass index ( P = 0.04), smaller low–lesser trochanter width (LLTW) ( P = 0.046), and more frequent use of the INTERTAN™ device ( P = 0.005). Multivariate regression identified reduced LLTW (odds ratio [OR] = 0.73) and INTERTAN™ implantation (OR = 12.66) as independent predictors. Traditional radiographic parameters – including reduction quality, medial cortical support, tip–apex distance, and the Cleveland index – were not associated with PIAFs. Sixteen PIAFs were nondisplaced and healed with protected weight-bearing, while one distal cortical fracture required revision to a long nail. Conclusions: PIAFs occurred in approximately 1 in 15 geriatric pertrochanteric fracture fixations. Narrow LLTW and INTERTAN™ use were independent risk factors. Careful attention to proximal femoral morphology and implant selection may help reduce PIAF risk.
Abstract Background: The arthroscopic modified Broström procedure (aMBP) with internal bracing has become an increasingly favored surgical option for managing anterior talofibular ligament (ATFL) injuries, particularly due to its potential to expedite return to daily activities and sports. However, the intrinsic quality of the ATFL and surrounding tissue remains a critical prognostic factor for successful anatomic repair. Magnetic resonance imaging (MRI) offers a noninvasive and powerful tool for evaluating ATFL integrity and associated intra-articular pathology. In particular, T2-weighted MRI signal intensity has been shown to correlate inversely with ligament biomechanical strength. Objectives: This study aimed to examine the relationship between MRI-based ligament characteristics and postoperative clinical outcomes in patients undergoing aMBP for ATFL injury. Materials and Methods: A retrospective analysis was conducted on 100 patients with confirmed ATFL injuries who underwent aMBP with internal bracing. Preoperative and 6-month postoperative MRI scans of the injured ankle were reviewed. Functional assessment was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score at baseline, 2 months, and 6 months postoperatively. ATFL morphology was categorized as wavy-shape or discontinuity on preoperative MRI. Radiographic parameters, including talar tilt angle and anterior talar translation, were also evaluated. Results: Both morphological groups demonstrated statistically significant postoperative improvements in AOFAS scores, talar tilt angles, and anterior talar translation ( P <.05). At 6 months postoperatively, all repaired ATFLs exhibited a continuous linear band structure on MRI, and 64.9% (63 of 97) demonstrated low signal intensity on T2-weighted sequences. The continuity group had a significantly higher prevalence of low signal intensity compared to the discontinuity group (80.9% vs. 50.0%, P < 0.05). Conclusions: aMBP with internal bracing effectively improved functional and radiological outcomes across all morphological subtypes. However, better preoperative ATFL morphology exhibited more favorable postoperative MRI characteristics, suggesting a higher capacity for biological healing and ligament maturation.
Abstract Background: Hip fracture is a common disease for older people, and operative management provides more benefits than conservative treatment. However, the optimal surgical options for geriatric patients with hip fractures remain debated. Objectives: To compare the clinical outcomes of hemiarthroplasty versus internal fixation in diabetic patients with a fragility hip fracture. Materials and Methods: This retrospective cohort study utilized data from the Taiwan National Health Research Insurance Database. Patients with type 2 diabetes who underwent hemiarthroplasty or internal fixation for a first-ever fragility hip fracture between 2000 and 2013 were enrolled. The primary outcome was the incidence of major surgical complications within 1 year after surgery. Secondary outcomes included in-hospital complications, length of stay, medical costs, readmission, and mortality. Results: After propensity score-matching, there were 26,499 patients in each group (hemiarthroplasty vs. internal fixation). Hemiarthroplasty was associated with higher rates of in-hospital complications, including delirium, urinary tract infection, pneumonia, and surgical site infections, but showed a lower risk of transfusion. After index hospitalization, hemiarthroplasty patients had an increased risk of deep infections (subdistribution hazard ratio [SHR] = 1.35 and 95% confidence interval [CI]: 1.15–1.60), but lower risks of revision surgery (SHR = 0.43 and 95% CI: 0.38–0.49) and overall surgical complications (SHR = 0.74 and 95% CI 0.67–0.81). Internal fixation patients demonstrated higher readmission risk at 3 months and 1-year follow-up. However, the mortality risk was comparable between these two groups. Conclusions: While hemiarthroplasty was associated with higher in-hospital complications, it offered advantages over internal fixation in reducing reoperation and readmission rates postdischarge, making it a viable option for diabetic patients with hip fractures.
Abstract Background: Optimal postoperative rehabilitation after rotator cuff repair remains debated, particularly regarding the comparative effectiveness of home-based versus hospital-based protocols. Objectives: This study aims to evaluate the short-term functional outcomes of home-based and hospital-based physical therapy (PT) in patients following double-row rotator cuff and subscapularis repair in the setting of Taiwanese population. Materials and Methods: A retrospective analysis was conducted on 30 patients who underwent double-row rotator cuff and subscapularis repair by a single surgeon. Patients were grouped according to their rehabilitation protocol: 11 received home-based rehabilitation and 19 received hospital-based rehabilitation. Baseline characteristics include age, gender, and preoperative frozen shoulder were compared. The primary endpoint was shoulder range of motion in forward flexion, abduction, external rotation and internal rotation, measured both actively and passively at 3 months postoperatively. Statistical comparisons were made for age, gender, and frozen shoulder. Results: Baseline demographics – mean age, gender distribution, and frozen shoulder prevalence – were similar between groups (all P > 0.7). At 3 months, both home-based and hospital-based groups demonstrated improvement in all ROM parameters. No statistically significant differences were found in active or passive ROM for forward flexion, abduction, internal, or external rotation between the two groups. Subgroup analysis for patients with frozen shoulder similarly revealed no significant differences in ROM outcomes. No major complications or adverse events occurred in either group during the follow-up. Conclusions: Home-based rehabilitation provides short-term shoulder mobility outcomes comparable to those of hospital-based PT after rotator cuff and subscapularis repair. Both protocols appear suitable for postoperative rehabilitation, with home-based protocols offering a feasible, resource-saving alternative for appropriate patients.
Abstract Background: Vertically expandable interbody cages are designed to restore disc height and reduce neural traction during lumbar fusion surgery. However, their effectiveness in correcting spinal alignment and their risk of subsidence, particularly in nonosteoporotic patients, remain unclear. Objectives: To evaluate the radiographic changes and the incidence, timing, and risk factors of cage subsidence following single-level lumbar fusion using vertically expandable cages in patients without osteoporosis. Materials and Methods: We retrospectively reviewed 34 patients who underwent single-level transforaminal lumbar interbody fusion with vertically uniplanar expandable cages between March 2023 and March 2024. Patients with osteoporosis, trauma, tumors, infections, or multi-level surgeries were excluded. Serial radiographs were obtained postoperatively at 1, 3, 6, and 12 months. Changes in disc height, foraminal dimensions, sagittal and coronal alignment, and cage subsidence were measured. Results: Significant increases were observed in disc height, foraminal height, and area postoperatively ( P < 0.01). No significant changes were found in lumbar or segmental lordosis ( P = 0.53, P = 0.47) or Cobb angle ( P = 0.71). Cage subsidence occurred in 16 patients (47%), all within the 1 st month. Subsidence was significantly associated with older age ( P = 0.04) but not correlated with cage position or degree of disc height increase. No neurological complications or revision surgeries were reported. Conclusions: Despite the exclusion of osteoporotic patients, the rate of early cage subsidence remained high. Alignment correction was minimal, and the theoretical benefits of sagittal or coronal correction were not evident. Vertically expandable cages may be most valuable in reducing neural traction in cases with large disc space, rather than alignment restoration.
Akin osteotomy is commonly performed in hallux valgus (HV) surgery, with debate over whether screw fixation is necessary. This study compared angular correction maintenance, healing time, and complications between screw fixation and nonfixation techniques in patients undergoing minimally invasive Chevron-Akin (MICA) with lesser metatarsal osteotomy. The primary outcome was proximal-distal phalangeal articular angle (PDPAA) change (6 months −1 month); secondary outcomes were healing time and overall complication rate. We tested the null hypothesis that there is no difference in the maintenance of angular correction between fixation and nonfixation, operationalized as the between-group difference in PDPAA change from 1 to 6 months postoperatively. This retrospective cohort study enrolled 53 patients (61 feet) undergoing MICA with lesser metatarsal osteotomy between January 2022 and December 2023, divided into fixation (36 feet) and nonfixation (25 feet) groups. Radiographic parameters (HV angle, intermetatarsal angle, interphalangeal angle, and PDPAA) were assessed preoperatively and at 1 and 6 months postoperatively. Complications and healing outcomes were also recorded. Both groups achieved 100% bone union with no significant differences in healing time and complications. Radiographic improvements were significant in both groups. The nonfixation cohort showed a small, borderline increase in PDPAA from 1 to 6 months (angle change + 2.2°; 95% confidence interval: 0.00–4.48; P = 0.05), while no significant change occurred in the fixation group. Screw fixation demonstrated more consistent maintenance of angular correction compared with nonfixation, which showed a small, borderline increase in PDPAA between 1 and 6 months. Although both techniques achieved comparable healing and complication rates, fixation appears to provide greater predictability in preserving correction. Larger, adequately powered prospective studies are needed to confirm whether this radiographic advantage translates into meaningful long-term clinical benefit.
Abstract Background: Patellar instability is commonly associated with abnormalities such as pathologic tibial tuberosity-trochlear groove (TT-TG) distance. Fulkerson osteotomy is a surgical intervention designed to address these issues by realigning the patella through anteromedialization of the tibial tubercle. However, postoperative management, particularly brace use and rehabilitation protocols, remains a subject of debate due to the concerns over complications such as arthrofibrosis and delayed recovery. Objectives: This study aims to evaluate the safety and efficacy of an accelerated free range of motion (ROM) rehabilitation protocol without brace protection following Fulkerson osteotomy for patellar instability. Materials and Methods: A retrospective case series was conducted on 10 patients (median age: 45.5 years) with patellar instability and TT-TG distances >20 mm who underwent Fulkerson osteotomy. Patients were allowed immediate postoperative weight-bearing and unrestricted ROM based on pain tolerance, without brace protection. Preoperative assessments included TT-TG distance, ROM, and pain scores, whereas postoperative evaluations included radiographic and clinical assessments at 1, 3, 6, and 12 months. Results: Postoperative outcomes demonstrated significant improvements, with median TT-TG distance reduced from 21.95 mm to 9.95 mm and ROM increased from 0°–90° preoperatively to 0°–111°. Pain scores decreased from a median of 6 preoperatively to 0.5 at 6 months. No cases of recurrence instability, delayed union, nonunion, or arthrofibrosis were observed within the 1-year follow-up. One patient with severe preoperative osteoarthritis required patellofemoral joint arthroplasty postoperatively. Conclusions: A pain-tolerated, free-range-of-motion rehabilitation protocol without brace protection after Fulkerson osteotomy is a safe and effective approach. This protocol facilitates faster functional recovery, reduces complications such as arthrofibrosis, and challenges conventional postoperative strategies. Further studies are necessary to validate these findings in larger patient cohorts.
Abstract The all-suture anchor is a specialized orthopedic device designed for treating labral tears in the shoulder. This device uses suture loops instead of a rigid body, offering benefits such as reduced bone removal, smaller size, biocompatibility, improved healing, and fewer imaging artifacts. Although complications associated with the use of all-suture anchors for shoulder labral repair are seldom reported, we present two cases where the stitch from an all-suture anchor cut through the glenoid bone during the repair of an anterior labroligamentous periosteal sleeve avulsion lesion in two patients. This unique incident highlights potential complications related to the design of implants and the severity of shoulder instability. This case report aims to increase the awareness of such complications and to promote further biomechanical research in this field.
The Bernese periacetabular osteotomy (PAO) has been the standard surgical treatment for adolescents and young adults with acetabular dysplasia. Despite its benefits, the procedure is technically demanding and associated with a steep learning curve. This study aimed to characterize the learning curve of PAO and assess perioperative and radiographic outcomes across different phases of surgical proficiency. We conducted a retrospective review of 132 consecutive PAO cases performed between 2013 and 2021 at a single academic center. Patient demographics, operative time, blood loss, length of hospital stay, radiographic parameters, and complications were analyzed. Cumulative summation analysis and segmented regression were used to define learning curve phases. Two inflection points were identified at cases 21 and 49, delineating the learning, proficiency, and competency phases. Operative time decreased significantly across phases (224.1–135.5 min, P < 0.001), along with intraoperative blood loss (811.9–554.8 mL, P = 0.007) and hospital stay (10.9–8.0 days, P < 0.001). Radiographic outcomes, including lateral center-edge angle, Tönnis angle, and anterior center-edge angle, improved significantly postoperatively. All revision surgeries ( n = 4) occurred during the learning phase. The upward rotation of the acetabular teardrop was proposed as a potential indicator of adequate mobilization of the acetabular fragment. Surgical proficiency in PAO was generally achieved after 21 cases, with continued refinement beyond 49 cases. The results suggest that operative efficiency and complication rates improve significantly with experience. These findings provide a framework for surgical training and program development in hip preservation surgery.
Intertrochanteric fractures (ITFs) are very common injuries seen in following ground-level falls in the elderly. In the most recent decade, the use of intramedullary (IM) devices to treat ITFs has gained popularity. O’Malley et al . first described the lateralization of the femoral shaft and the femoral neck varus malalignment occur following IM nail fixation for ITF. The objective of this study was to the best of our knowledge, no study has investigated the association between the wedge effect in patients with ITF and postoperative functional outcomes in a large cohort with a minimum 1-year follow-up. This study aims to evaluate the function outcomes and radiological outcomes of the wedge effect in patients with ITFs. Three hundred and seventy-seven patients with ITFs fixed with proximal femoral nail were assessed. The medialized greater trochanter and the “crossing wire sign” were used as predictors of iatrogenic varus displacement. Function and clinical outcomes were measured by the Harris hip score (HHS), Visual analog scale (VAS), and nonunion rate. Radiological outcome was measured by tip apex distance (TAD), any changes in neck shaft angle, and cutout of the cephalic component. The mean VAS was 1.82 for Group A and 1.57 for Group B. The mean HHS of the wedge effect group was 81.5, and no wedge effect group was 84.3. Furthermore, the mean TAD in patients with wedge effect was higher in those without wedge effect (27.4 mm vs. 23.3 mm, P = 0.069). The blade cutout rate was significantly higher in patients with wedge effect than in those without wedge effect (18% vs. 5%, P = 0.037). This study showed that the wedge effect increases the risk of blade cutout. We did not observe a significant association between the wedge effect and union rate.
In recent decades, the incidence of nontuberculous mycobacteria (NTM) has significantly increased in Taiwan. Compared to NTM pulmonary diseases, NTM hand and wrist infections are uncommon and can affect immunocompetent patients. Unfortunately, the optimal management remains unknown, and comprehensive studies are lacking. Our aim was to determine the clinical features of hand and wrist NTM infections and establish protocols for treating such diseases. We included seven patients with hand and wrist NTM infections treated with surgical intervention followed by a medical regimen at a single tertiary medical center between 2008 and 2023. One patient was excluded due to dead of lymphoma before 1 year follow. Age, sex, occupation, trauma history, underlying disease, infective location, time from symptoms to surgery, debridement times, staining and microbiological results, pathological findings, interval to final microbial findings, initial medical regimen and regimen adjustments, treatment duration, recent condition, grip power, functional score, and pain score were recorded. One died of lymphoma before a 1-year follow-up. In the remaining 6 patients, the median time from symptom onset to surgery was 4 months (range, 2–12 months) and the median interval before the final mycobacterium report was 39 days (range, 13–56 days). One patient tested positive for acid fast stain (AFS), while three were infected with the Mycobacterium Avium Complex (MAC) , two with Mycobacterium szulgai , one with Mycobacteroides Abscessus , and Mycobacterium kansasii . Except for Case 5, all patients experienced drug side effects and required medical adjustment. All patients except two had better functional outcomes after surgery. Surgical debridement followed by combination therapy may be effective in improving the outcomes and quality of life of patients with hand and wrist NTM infections. The most common identified pathogen was MAC . However, the clinical features and protocols for NTM infection management are still lacking in Taiwan. Surgeon awareness of NTM infection by improving clinical decision-making criteria, laboratory research, and multicenter controlled trials are required to improve the diagnosis and treatment of hand and wrist NTM infections.
Abstract Distinguishing between neurogenic and vascular claudication can be challenging in older patients with degenerative spinal changes and cardiovascular risk factors. We report the case of a 71-year-old male with a 4-year history of exertional left buttock pain without initial presentation of diminished peripheral pulses, skin discoloration, temperature variations, poor hair growth, or trophic skin changes presumed to be neurogenic based on magnetic resonance imaging of L2–L3 lumbar spinal stenosis. He underwent two diagnostic transforaminal epidural steroid injections, followed by endoscopic interlaminar decompression without improvement. Subsequent evaluation revealed a reduced left ankle-brachial index (ABI; 0.71), and computed tomography angiography revealed total occlusion of the left common iliac artery with segmental involvement of other pelvic arteries. The patient underwent successful percutaneous transluminal angioplasty with stenting, which resolved symptoms. Proximal iliac disease could be easily missed in clinical settings with normal distal pulses due to collateral circulation. ABI testing and vascular imaging should be integrated into the diagnostic pathway.
Background: Enhanced recovery after surgery (ERAS) protocols have been increasingly adopted in joint reconstruction surgeries to reduce costs, improve efficiency, and optimize outcomes. Objectives: This study evaluates the preliminary effects of ERAS in elderly patients (>80 years) undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) on hospital length of stay (LOS), morbidity, and readmission rates. Materials and Methods: Patients who received elective TKA or THA from a single tertiary center were retrospectively reviewed. Two groups were compared: patients treated with standard care in 2023 and those recruited in the ERAS protocol from June to December 2024. Outcomes assessed contained mean age, LOS, morbidity, and 30-day readmission rates. Results: Among 56 patients in the non-ERAS group (mean age 84.1), the overall LOS was 7.61 days with 7 morbidity cases (12.5%) and no readmissions. In the ERAS group (n = 14, mean age 83.2), LOS decreased to 7 days and no morbidity or readmissions were observed. For non-ERAS TKA and THA, LOS was longer (7.36 and 8.5 days, respectively) with higher morbidity rates (11% and 17%). Conclusions: Preliminary results suggest that ERAS ameliorate perioperative outcomes in elderly patients receiving joint replacement surgery, although the findings are exploratory and not definitive. Additional large-scale research is needed to confirm these findings and to clearly demonstrate the advantages of ERAS in Taiwan.
Background: Bilateral knee osteoarthritis management with Oxford unicompartmental knee arthroplasty (OUKA) has demonstrated promising survival rates. Simultaneous OUKA optimizes costs and recovery but may increase perioperative risks, whereas staged OUKA allows for controlled recovery in high-risk patients. Comparable outcomes necessitate patient-specific approaches that emphasize the importance of diagnosis-related group (DRG)-driven cost efficiency in healthcare resource allocation. Objectives: This study aimed to evaluate the safety, functional and radiographic outcomes, complications, and potential DRG bonuses in simultaneous bilateral OUKA compared with staged bilateral OUKA. Materials and Methods: A retrospective cohort study was conducted on 37 patients with bilateral knee osteoarthritis (74 knees) treated by a single surgeon at a single medical center between 2019 and 2024. Functional outcomes were assessed using the Knee Society Score. The DRG of a single admission period and complications within 30 days were documented. Results: Patient demographics, comorbidities, and perioperative factors showed no significant differences between the simultaneous and staged OUKA groups, except for greater hemoglobin reduction in the simultaneous group (P < 0.0001). Functional scores and implant parameters were comparable between groups. Simultaneous procedures resulted in lower hospital costs (P < 0.0001) and higher DRG bonuses (P = 0.008) than those of staged procedures. Conclusions: Simultaneous bilateral OUKA did not lead to increased complication rates or worsened functional scores. Moreover, it offers the benefits of shorter hospital stays and increased DRG bonuses.
Background: Intravertebral device implantation is a safe and effective treatment for thoracolumbar vertebral fractures. Unilateral intravertebral stenting using a self-expanding implant can achieve anatomic reduction percutaneously through posterolateral transpedicular access. Objectives: This study analyzed clinical and radiological data on patients receiving intravertebral stenting using the expandable vertebral augment (EVA) system and reviewed currently available intravertebral implants. Materials and Methods: This was a retrospective cohort study. A retrospective review of 18 patients with vertebral compression fractures who underwent EVA intravertebral augmentation between 2020 and 2022, with an average of 1-year follow-up, was performed. Data collected pre-, postoperatively, and at final follow-up were patient-reported outcomes, including Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores; radiological assessment, including kyphotic angle; vertebral body height (anterior, middle, and posterior), and recovery rate; complications, including postoperative adjacent segment fracture and cement leakage. Results: Twenty levels of the vertebral body were operated on. The mean VAS and ODI scores, the anterior, middle, and posterior vertebral body heights, and the average kyphotic angle all showed significant improvement postoperatively. One postoperative adjacent segment fracture and one cement leakage were noted. No significant changes were found in all parameters during the postoperative period till final follow-up, indicating a sustained and favorable outcome. Conclusions: Intravertebral stenting in the treatment of vertebral compression fractures offers advantages in terms of restoring vertebral body height and kyphotic angle and has a low risk of bone cement leakage. Unilateral application of a single implant requires certain surgical experience due to a more horizontal trajectory.
Background: Rupture at tendon repair sites in animal models impedes the study of healing. To address this, we investigated “safe incisions” – strategic partial transections to prevent rupture under excessive force. We hypothesized these would act as mechanical “fuses,” reducing repair site tension. Objectives: This in vitro biomechanical study optimized safe incision spacing to enhance tendon construct strength and minimize gap formation in a turkey flexor tendon model. Materials and Methods: Forty turkey flexor tendons were divided into five groups (n = 8): Repaired without incisions, intact with 5 mm incisions, repaired with 5 mm incisions, intact with 10 mm incisions, and repaired with 10 mm incisions. Repairs used a modified Pennington suture. Safe incisions (opposing hemi-transections) with 5 mm or 10 mm longitudinal spacing were created proximally. Tendons were tested to failure at 1 mm/s, recording force-elongation, failure mode, gap formation (>2 mm at 10% strain), stiffness, and repair site elongation. Results: Repaired tendons without incisions (Group 1) showed 100% repair site failure (46.5 ± 10.96 N). With 5 mm safe incisions (Group 3), no repair site failures occurred (incision failure at 18.11 ± 10.96 N). 10 mm incisions (Group 5) offered partial protection (25% repair failure at 37.48 ± 11.35 N). Group 1 had higher gap formation (75% vs. 0% in Group 3, P < 0.01), stiffness, and repair site elongation than Groups 3 and 5. Gap formation force was similar for Group 1 (25.76 ± 9.18 N) and Group 5 (25.04 ± 12.21 N). Conclusions: In this in vitro model, 5 mm spaced safe incisions effectively shifted failure away from the repair and limited gap formation by reducing stiffness. 10 mm incisions provided partial protection. Strategically placed safe incisions show potential to protect tendon repairs from immediate rupture by enabling controlled lengthening at a weaker site. However, tendinopathy risk and clinical relevance require in vivo studies.
