This study aims to assess the quality, user friendliness of current smartphone applications ("apps") available for total hip (THR) and total knee (TKR) arthroplasty patients and identifies patient preferences regarding the content of an ideal rehabilitation app. ® ® The Google Play and Apple app stores were systematically searched. The Mobile App Rating Scale (MARS) and the Systematic Usability Scale (SUS) were used for the assessment of apps. A questionnaire was designed and used in a post op orthopaedic clinic at a large tertiary center. 102 patients (52 TKR and 50 THR) completed the questionnaire. Nine apps were included in the systematic review. On MARS assessment, the mean overall score was 3.55/5. The highest and lowest mean scores were seen in the functionality (3.86/5) and aesthetics (3.44/5) subscales respectively. The mean overall SUS score was 75.3/100 (Grade B) with a range of 51.25 - 95. Both scales suggested moderate levels of quality and user friendliness of currently available apps, but with significant variation between apps. Patient preferences are not currently ideally matched by available apps.
Subclinical bacterial colonization of osteosynthesis implants has been suggested as a potential contributor to subsequent periprosthetic joint infection, yet its frequency in clinically uneventful fracture healing remains unclear. This prospective cohort study aimed to determine the prevalence of unexpected positive intraoperative cultures (UPIC) during elective hardware removal after uncomplicated fracture union. Adult patients undergoing elective implant removal after radiographic union were prospectively enrolled. Inclusion required absence of signs of clinical infection and no antibiotic therapy within 48 hours before surgery. Three deep tissue samples were collected from the implant-bone interface prior to irrigation. Samples were homogenized and inoculated into aerobic and anaerobic blood culture bottles. UPIC were defined as culture growth without clinical suspicion. Microbiological confirmation required at least two concordant isolates according to the FRI consensus definition. Sixty-nine patients were included. Any bacterial growth occurred in 32 patients (46.4%). Seventeen patients (24.6%) had two or more concordant isolates fulfilling microbiological criteria, whereas 15 (21.7%) had a single low-virulence isolate interpreted as contamination. UPIC were most frequent in the shoulder, predominantly Cutibacterium acnes, followed by the elbow with mainly coagulase-negative staphylococci. No postoperative infections, wound complications, or reoperations occurred. Nearly one quarter of clinically unremarkable hardware removals yielded multiple concordant isolates, indicating a substantial rate of low-grade infection. Although no short-term clinical consequences were observed, the potential relevance of UPIC for future arthroplasty remains uncertain.
The study aimed to explore the therapeutic effect of catalpol on articular chondrocyte senescence and osteoarthritis through cell experiments, and to explore the role of NF-κB and its upstream and downstream pathways in the therapeutic process. Rat primary chondrocytes were isolated. catalpol was added to evaluate cytotoxicity and cell viability, and the optimal catalpol concentration was determined accordingly. IL-1β was added to simulate OA inflammation, establish a cellular senescence model and detect senescence-associated β-galactosidase activity. The proportion of senescent cells, cell cycle distribution, and ROS levels in each group were measured and compared. Western blotting was used to detect the expression of Type II collagen, ADAMTS-5, MMP-13, IL-6, p16, p21, PI3K, p-PI3K, AKT, p-AKT, p65, and p-p65 proteins. After catalpol treatment, the proportion of positive chondrocytes decreased, the proportion of chondrocytes in G0-G1 phase decreased significantly, and the ROS levels of chondrocytes in the inflammatory rat model decreased significantly. IL-1β significantly elevated the expression of IL-6, p16, and p21. However, this effect of IL-1β was inhibited by catalpol. catalpol could significantly inhibit the expression of MMP-13, IL-6, ADAMTS-5, p16, and p21, significantly increased the expression of type II collagen, and significantly inhibited the activation of PI3K/AKT and NF-κB signaling pathways. Catalpol attenuated chondrocyte senescence in an IL-1β-induced in vitro OA model, suppressed PI3K/AKT/NF-κB signaling, and decreased SASP expression. These in vitro findings suggest a potential mechanistic basis for the anti-senescence effects of catalpol on chondrocytes, which requires further validation in animal models and clinical studies before any therapeutic conclusions can be drawn.
Ethical, legal, and economic considerations, alongside working-hour restrictions, have reduced opportunities for surgical training in the operating theatre, prompting the adoption of hands-on workshops as an alternative approach. These workshops provide trainees with a controlled environment to develop technical skills, decision- making, and confidence using a variety of simulation modalities, including synthetic models, cadaveric specimens, and virtual reality platforms. This scoping review aimed to map the existing literature on hands-on workshops in orthopaedic surgical training and examine how their educational design and outcomes are reported. A systematic search of PubMed, Cochrane Library, Embase, and Google Scholar was conducted for English-language studies published within the past 10 years, focusing on trauma and orthopaedic training for medical students and healthcare professionals. Review articles, letters, and non-English publications were excluded. Forty-five studies met inclusion criteria, most reporting improvements in performance-based outcomes following participation in hands-on workshops. Commonly used modalities included synthetic simulators, arthroscopy trainers, and virtual reality, with fewer studies incorporating cadaveric specimens. Reported outcomes included technical performance, procedural efficiency, and trainee confidence, primarily assessed in simulated or cadaveric settings. Findings were heterogeneous, and evidence linking workshop participation to direct clinical outcomes was limited. Resource considerations, including cost and accessibility, were frequently noted as challenges. Overall, the literature suggests that hands-on workshops and simulation-based interventions are widely employed in orthopaedic training and are associated with improvements in educational outcomes. These findings highlight the potential role of hands-on workshops in surgical education while underscoring the need for further research to clarify their translati.
Unicameral bone cysts (UBCs) are benign fluid-filled bone lesions that primarily affect children and adolescents and carry a clinically relevant risk of pathological fracture. This study explored radiological and clinical variables associated with fracture and recurrence in a histologically confirmed retrospective cohort. Seventy-two patients with histologically confirmed UBCs treated between 2010 and 2021 were retrospectively analysed. Median follow-up was 38 months (range 24-132). Primary outcomes were pathological fracture and radiological recurrence. Because only eight fractures were observed, multivariable analyses were treated as exploratory. Pathological fractures occurred in 8/72 patients (11.1%). Fracture rates were 0/46 (0%), 2/20 (10%) and 6/6 (100%) for Capanna stages 1, 2 and 3, respectively (p < 0.001). Latent cysts had a higher fracture rate than active cysts (21.4% vs 4.5%; p = 0.049). Recurrence occurred in 7/71 evaluable patients (9.9%), exclusively in the interventional group (7/23, 30.4% vs 0/48; p < 0.001). In this retrospective, histologically selected cohort, higher Capanna stage, younger age, latent activity and diaphyseal localisation were associated with fracture risk. Given the limited number of fracture events, the mixed paediatric-adult population and the selection bias inherent to histological inclusion, these findings are best interpreted as exploratory and hypothesis-generating. Overall, they may be more compatible with structured, individualised risk assessment than with a prescriptive Capanna-guided treatment algorithm.
Cobb angle measurement is essential for diagnosing and monitoring scoliosis; however, its accuracy varies with observer experience. In many healthcare systems, including Oman, initial measurements are commonly performed by residents and influence referral urgency, follow-up intervals, and bracing decisions, where even small inaccuracies may alter clinical pathways. This study evaluated the inter- and intra-observer reliability of Cobb angle measurement among orthopaedic residents and spine specialists. A prospective comparative reliability study was conducted including 18 OMSB orthopaedic residents (PGY2-5) and five spine specialists. Each participant measured Cobb angles on five standardised standing scoliosis radiographs on two occasions, four weeks apart. Inter- and intra-observer reliability were assessed using the intraclass correlation coefficient (ICC) with a two-way random-effects, single-measurement, absolute-agreement model [ICC(2,1)], and Bland-Altman plots were used to assess intra-observer reproducibility. Mean Cobb angles ranged from 45° to 56°. Inter-observer reliability was poor among residents (ICC = -0.219; 95% CI -1.41 to 0.485) and remained low among specialists (ICC = 0.120; 95% CI -2.28 to 0.898). Intra-observer variation averaged approximately 5°, with a Bland-Altman mean bias close to zero and limits of agreement of ±5%. Negative ICC values indicated that between-observer variability exceeded within- observer consistency. Residents demonstrated markedly poorer inter-observer reliability compared to specialists, highlighting the impact of clinical experience on accurate end-vertebra selection and angle measurement. Targeted training modules and structured exposure during residency may improve measurement consistency, referral accuracy, and overall scoliosis management pathways.
BACKGROUND:Total hip arthroplasty is a common orthopedic procedure with significant hemorrhagic risks, often necessitating postoperative transfusions to treat anemia. Transfusions carry considerable costs and complications, including infection, necessitating judicious use. Identifying factors influencing transfusion rates in hip arthroplasty can improve perioperative management. PATIENTS AND METHODS:Records of 3,865 patients who underwent primary total hip arthroplasty at a university center from 2002 to 2020 were retrospectively reviewed. Factors analyzed included age, sex, BMI, ASA physical status classification, surgical indication, operation duration, surgical approach, additional procedures, hospital stay duration, intraoperative complications, postoperative infections, anticoagulation, tranexamic acid use, anti- inflammatory use, and pre- and postoperative hemoglobin levels. Data were analyzed using descriptive, univariate, and multivariate analyses. RESULTS:The overall transfusion rate was 9.4%. Transfusion rates decreased from 28.5% (2002-2003) to 11.3% (2004-2012) and 4.3% (2013-2020). Multiple logistic regression showed that female sex, surgical indication, surgical approach, longer operative time, higher ASA scores, and greater postoperative hemoglobin drop significantly increased transfusion risk. Conversely, tranexamic acid and anti-inflammatory use, and higher body weight significantly decreased transfusion risk. Infection rates were higher among transfused patients (3%) compared to non-transfused patients (0.83%). CONCLUSION:Reducing transfusion use is essential due to the scarcity of blood, associated costs, and complications, necessitating a standardized transfusion policy and perioperative care protocols. Optimizing preoperative hemoglobin, using controlled hypotension anesthesia, minimally invasive surgical approaches, consistent surgical techniques, perioperative tranexamic acid, and postoperative anti-inflammatory use are crucial to reducing.
Chondrosarcoma is a common bone sarcoma in adults with limited therapeutic options due to frequent chemoresistance. Cisplatin (CDDP) is a key chemotherapeutic agent, but resistance often develops. This study investigated the role and mechanism of circular RNA HMGB2 (circHMGB2) in cisplatin resistance of chondrosarcoma. Clinically, circHMGB2 was upregulated in chondrosarcoma tumors and associated with cisplatin resistance and poor patient survival. Functionally, exogenous overexpression of circHMGB2 elevated cisplatin resistance in chondrosarcoma cells (SW1353, OUMS-27) in vitro, while its silencing re-sensitized resistant cells. Mechanistically, circHMGB2 did not function as a miRNA sponge but acted as a competitive molecular decoy for the RNA-binding protein IGF2BP1. We demonstrated that circHMGB2 directly binds IGF2BP1, competitively impairing IGF2BP1's binding to and stabilization of Grb10 mRNA, leading to its destabilization and subsequent downregulation of Grb10 protein. This suppression of Grb10, a known negative regulator of the PI3K/Akt pathway, resulted in constitutive Akt phosphorylation, driving resistance. Crucially, co-overexpression of IGF2BP1 rescued circHMGB2-induced Grb10 downregulation, Akt activation, and cisplatin resistance, validating the decoy mechanism. Furthermore, in a cisplatin-resistant xenograft model, silencing circHMGB2 synergized with cisplatin to significantly inhibit tumor growth, improve host survival, and upregulate intratumoral Grb10 while suppressing Akt phosphorylation. Our results delineate a novel circHMGB2/IGF2BP1/Grb10/Akt axis that drives cisplatin resistance in chondrosarcoma. Targeting circHMGB2 could therefore serve as a promising therapeutic strategy to overcome chemoresistance and enhance treatment efficacy.
Despite advances in total knee arthroplasty (TKA), 7-15% of patients remain dissatisfied with surgical outcomes. Variability in implant positioning and limb alignment are recognized contributors. This study evaluates the surgical precision, coronal alignment, and early clinical safety of an imageless robotic system (VELYSTM Robotic-Assisted Solution) compared to conventional instrumentation. We retrospectively reviewed 342 consecutive TKAs performed between September 2021 and May 2024: 198 with conventional instrumentation and 144 with robotic assistance. Clinical parameters included anterior femoral notching, tibial stem placement, and insert size. Radiographic outcomes included mechanical hip-knee-ankle axis (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and joint line orientation (JLO). Complication rates within one year were recorded. Femoral notching was significantly reduced in the robotic group (13.9% vs. 25.3%, p = 0.04). Tibial stem extension was less frequently required (15.3% vs. 24.2%, p = 0.01). Average insert thickness was reduced (5.7 ± 0.83 mm vs. 6.04 ± 0.98 mm, p = 0.003). Radiographic analysis of 225 patients demonstrated reduced variability in postoperative alignment with robotic assistance, including fewer alignment outliers and lower incidence of unintended valgus tibial cuts. Complications occurred in 10 manual and 6 robotic cases, with no events attributable to the robotic system. The Velys Robotic-Assisted Solution demonstrated improved surgical precision and radiographic outcomes compared to conventional TKA. Through enhanced intraoperative guidance, surgeon decision-making resulted in reduced femoral notching and stem usage, with more consistent implant positioning. These findings support imageless robotic assistance as a safe and effective enabling technology in TKA.
Klotho is an anti-aging protein involved in phosphate homeostasis, oxidative stress regulation, and tissue regeneration. Although circulating Klotho levels decline with chronological aging, its response to acute disuse- induced skeletal muscle alterations remains unclear. In this experimental study, sixteen male Wistar rats (3 months old) were randomly assigned to a control group (n = 8) or an intermittent hindlimb unloading group (3 h/day for 15 consecutive days) (n = 8). Skeletal muscle morphology was evaluated in the extensor digitorum longus (EDL) and soleus muscles using hematoxylin-eosin staining, and muscle fiber cross-sectional area (CSA) was quantified with ImageJ software. Interstitial connective tissue changes were qualitatively assessed using Masson's trichrome staining, and serum Klotho concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Intermittent unloading induced histological features consistent with early disuse-associated muscle remodeling in both EDL and soleus muscles, accompanied by a modest reduction in muscle fiber CSA compared with controls. Serum Klotho levels were significantly lower in the unloading group (7.44 ± 0.54 vs 8.21 ± 0.81, p = 0.045), and a moderate positive correlation was observed between circulating Klotho concentrations and mean muscle fiber CSA (r = 0.58, p = 0.02). Mild interstitial connective tissue expansion was qualitatively noted in the soleus muscle following unloading. These findings suggest that short-term intermittent hindlimb unloading in young adult rats is associated with reduced circulating Klotho levels and mild skeletal muscle remodeling. Serum Klotho may represent a candidate biomarker of early disuse-associated muscle alterations; however, further studies are required to confirm its clinical applicability. These results may have potential implications for orthopedic conditions characterized by immobilization, including fracture treatment, casting, and postoperative rehabilitation.
Postural changes occurring during prolonged smartphone usage may be associated with impaired proprioception, altered musculoskeletal dynamics, and structural alterations in the cervical region. This study aimed to investigate the association between smartphone addictive use and cervical paraspinal muscles morphology and vertebral degeneration in patients with chronic neck pain (NP). This study included 119 patients with chronic NP. The cross-sectional areas (CSA) of the paraspinal muscles were quantified from magnetic resonance imaging (MRI) slices using the software program ImageJ 1.53. The relationship between the Smartphone Addiction Scale-Short Version (SAS-SV) and cervical paraspinal CSAs as well as cervical intervertebral disc degeneration was analyzed. A weak positive correlation was observed between SAS-SV scores and degeneration at C2-C3, C3-C4, C4-C5, C5-C6, and C6-C7 (p<0.05). Conversely, a weak negative correlation existed between SAS-SV and the CSAs of the sternocleidomastoid (SCM), trapezius, scalene muscles (anterior, middle, posterior), multifidus, multifidus+semispinalis, levator scapulae muscles and the posterolateral, lateral, and anterior muscle groups (p<0.05). Prolonged smartphone use may be associated with subtle reductions in cervical paraspinal muscle CSA and increased disc degeneration; however, these associations remain modest and should be interpreted cautiously. Given the prevalence of smartphones in contemporary lifestyles, individuals with neck pain may benefit from limiting continuous device use and incorporating postural breaks. Patients may also benefit from appropriately designed exercise programs aimed at improving cervical stability, reducing pain, and preserving paraspinal muscle integrity and function.
Hemicortical resection (HCR) is a limb salvage option for eccentrically located bone sarcomas that allows preservation of native bone stock and nearby joint anatomy. Evidence on outcomes in high-grade extremity sarcomas remains limited. We performed a retrospective case series of consecutive patients undergoing HCR for high-grade primary malignant bone tumors of the extremities. Collected variables included demographics, tumor type and location, systemic therapy, local radiotherapy, radiographic union, time to union, complications, local recurrence, distant metastasis, survival status, and last follow-up. Five patients were included (mean age 14.2 years; 3/5 female). Diagnoses were Ewing sarcoma (n = 3) and osteosarcoma (n = 2). Sites were distal femur (n = 2), proximal tibia (n = 1), distal tibia (n = 1), and tibial shaft (n = 1). One patient received local radiotherapy. Union was achieved in all cases. Median time to union was 8.2 months (mean 11.1; range 4.4-18.9). Median follow-up was 20.8 months (mean 19.3; range 11.7-23.4). Complications included one infection treated with antibiotics and one late implant exposure requiring debridement and flap coverage. No local recurrences, distant metastases, or deaths were observed at last follow-up. In this small series, HCR with biological reconstruction achieved universal union and a low early complication rate. No local recurrence, distant metastasis, or death was observed during the available follow-up; however, oncologic safety cannot be inferred from this limited cohort, and larger studies with longer follow-up are required. INTRODUCTION tumor-bearing autograft devitalized by methods such as liquid nitrogen (LN), pasteurization, irradiation, 5-7 Limb salvage surgery has become the standard of care or ethanol . Among these, LN-treated autograft is for most localized high-grade extremity sarcomas widely used because it delivers rapid, deep cytocidal when wide margins are achievable and function can temperatures while p.
Bilateral sternoclavicular joint (SCJ) dislocation is an exceptionally rare injury, particularly when associated with inferior migration of the sternal body and multiple rib fractures. We report the case of a 51-year-old male who sustained high-energy thoracic crush trauma resulting in bilateral SCJ dislocation, inferior sternal displacement, rib fractures, and a Grade I open humeral shaft fracture. Surgical management required a multidisciplinary approach including SCJ reduction, ligament reconstruction with a semitendinosus tendon graft in a figure-of-eight configuration, clavicular fixation, and delayed intramedullary nailing of the humeral shaft. Postoperatively, neuropathy secondary to a C8-T1 brachial plexus injury was diagnosed; it was considered traumatic in origin, as no intraoperative manipulation occurred. At one-year follow-up, full functional recovery was achieved in the right upper limb, whereas residual limitation on the left side was attributable to persistent neurological involvement rather than mechanical instability. This case represents an uncommon combination of bilateral SCJ dislocation with inferior sternal migration and associated thoracic and neurological injuries, providing relevant surgical and clinical insights.
Giant cell tumor (GCT) of the hand is a rare benign but locally aggressive bone tumor with high recurrence rates. It is commonly treated by curettage with cementation or bone grafting. However, reconstruction after en bloc resection of metacarpal GCT remains challenging, particularly in young patients. Conventional options such as allografts or standard prostheses are associated with notable complications and functional limitations. Custom- made 3D-printed implants have recently emerged as a potential alternative, although current evidence is limited. We report the case of a 19-year-old woman with a recurrent GCT of the third metacarpal following initial curettage and cementation. After neoadjuvant denosumab therapy, an en bloc resection of the third metacarpal was performed. Reconstruction was achieved using a patient-specific 3D-printed titanium hemiarthroplasty featuring an intramedullary stem, screw fixation, porous surfaces for osseointegration, and dedicated structures for ligament reinsertion to ensure hand stability. Early postoperative mobilization was allowed. At mid-term follow-up, the patient demonstrated excellent functional recovery, high total active motion, minimal pain, and no complications, implant instability, or tumor recurrence. Custom-made metacarpal hemiarthroplasty appears particularly suitable for reconstruction of central rays, where transverse stability is supported by adjacent structures. This case supports patient-specific 3D-printed hemiarthroplasty as a promising reconstructive option, providing favorable early functional outcomes while preserving joint biomechanics. Further studies are needed to assess long-term durability.
The iliopsoas plane block (IPB) is a novel motor-sparing analgesic technique for hip surgery. While promising, its clinical benefits over conventional nerve blocks remain uncertain due to limited evidence. This systematic literature review evaluates postoperative pain, quadriceps strength, and quality of recovery after ultrasound-guided iliopsoas plane block (IPB) compared with conventional analgesic nerve blocks in hip surgery. It is hypothesized that IPB reduces postoperative pain and opioid consumption, without a decline in quadriceps strength. Following PRISMA guidelines, we systematically reviewed studies on IPB in patients undergoing hip surgery under general anesthesia. Databases were searched up to May 2025. Seven RCTs and two case series were included, assessing postoperative pain, opioid use, and quadriceps strength. One RCT reported significantly lower pain scores with IPB compared with sham, while other studies found no significant differences compared with sham or other blocks. Two RCTs showed reduced opioid consumption with IPB, while others showed no difference. Postoperative opioid consumption after IPB was significantly less in two out of four studies after surgery (p < 0.001). Regarding postoperative quadriceps strength, one study showed superior strength in the IPB group compared with the femoral nerve block (FNB) group at various time points (p < 0.05), whereas other studies found no significant differences or reductions in strength compared with sham (p > 0.05). Seven RCTs showed mixed results in postoperative outcomes. Our findings show that multiple studies reveal that IPB may influence postoperative pain and opioid use while highlighting its potential to preserve quadriceps strength. INTRODUCTION This pain can impede their ability to move, prolonging their hospital stay, and negatively impacting their 8 Hip arthroplasty is one of the most frequently performed postoperative functionality . In addition, uncontrolled 1 and successful surgical int.
INTRODUCTION:While knee kinematics are well-documented in primary TKA, less is understood regarding revision TKA (rTKA), where altered soft tissue conditions may influence kinematics. This study aimed to investigate the relationship between kinematic parameters, specifically anteroposterior (AP) translation and post-cam engagement, and patient-reported outcome measures (PROMs) in rTKA patients. MATERIALS AND METHODS:Thirty patients who underwent rTKA between 2022 and 2024 were assessed at a minimum six-month follow-up. Tibiofemoral kinematics, measured as femoral AP translation relative to the tibia, were evaluated during open-chain flexion-extension (FE) and closed-chain exercises (sit-to-stand (STS) and a lunge) using fluoroscopy. Two clusters, categorized by higher and lower PROMs, were compared for AP translation and post-cam engagement. RESULTS:In the medial compartment, the low-PROMs group exhibited a more anterior femoral position compared to the high-PROMs group, with statistical significance observed during mid-flexion of the STS (50.87% (SD, 4.04) vs. 47.57% (SD, 2.75); p = 0.043) and FE exercise (51.97% (SD, 3.83) vs. 48.55% (SD, 3.62); p = 0.037). No significant differences were found in the lateral compartment. Post-cam engagement did not differ between the groups in either open- or closed-chain exercises. CONCLUSIONS:Poorer PROM scores were associated with a more anterior femoral position in the medial compartment during mid-flexion of STS and FE exercises. Further research is needed to explore the relationship between kinematic variations and PROMs in rTKA patients.
Primary fibular tumors, whether benign or malignant, are uncommon and include entities such as osteochondroma, giant cell tumor, aneurysmal bone cyst, Ewing sarcoma, and osteosarcoma. Optimal management depends on careful radiological assessment to guide precise surgical planning and achieve adequate oncological outcomes. This study assessed surgical technique with post-treatment sequelea and survival analysis for fibular tumors. This retrospective study analyzed 22 patients with primary fibular tumors who underwent surgical resection at the National Cancer Institute, Cairo University, Egypt, between January 2013 and January 2023, evaluating clinical characteristics, treatment modalities, surgical techniques, postoperative sequelae, and survival outcomes. All patients presented with leg swelling, and the proximal fibula was the most frequently involved site (81.8%), followed by the distal fibula and diaphysis (each 9.1%). Osteosarcoma was the most common histopathological diagnosis (40.9%), followed by Ewing sarcoma (27.3%), giant cell tumor (22.7%), and chondrosarcoma (9.1%). Neoadjuvant therapy was administered in 68.2% of cases. Surgical management included proximal fibulectomy in 36.4% of patients, segmental resection in 27.3%, and above-knee amputation in 13.6%, with preservation of the common peroneal nerve achieved in 68.2% of patients. With a median follow-up of 32 months, the overall recurrence rate was 50%, including 22.7% among osteosarcoma cases. Overall survival rates at one, two, and three years were 94.4%, 75.4%, and 50.2%, respectively, while event-free survival rates at one, two, and three years were 79.4%, 56.3%, and 42.9%. The fibula presents unique surgical challenges due to its anatomical relationship with critical neurovascular structures, particularly the common peroneal nerve, and its contribution to knee and ankle stability; therefore, meticulous preoperative planning and appropriate surgical techniques are essential to achieve safe tumor res.
Medial open-wedge high tibial osteotomy (HTO) is a well-established joint-preserving procedure for medial compartment osteoarthritis with varus malalignment. However, unintended changes in posterior tibial slope (PTS) may occur and affect knee biomechanics and cruciate ligament loading. This retrospective cohort study included 60 patients who underwent medial open-wedge HTO between 2018 and 2024. We investigated whether sagittal plate position on postoperative lateral radiographs (anterior vs posterior) influenced postoperative PTS change and its association with coronal alignment and short-term functional outcomes. Radiographic assessments included PTS, tibiofemoral angle, hip-knee-ankle angle, and mechanical axis deviation. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) Knee Score and the Tegner Activity Scale. Multivariable linear regression was used to determine whether plate position independently predicted ΔPTS. The posterior plate group demonstrated a significantly greater increase in PTS than the anterior group (ΔPTS 4.3° ± 1.6° vs 0.9° ± 1.2°, p < 0.001), and postoperative PTS ≥12° was more frequent in the posterior group (67% vs 10%, p < 0.001). Coronal alignment parameters and functional scores were comparable between groups (all p > 0.05). Sagittal plate position was independently associated with postoperative PTS change after medial open-wedge HTO. Posterior placement resulted in greater slope increase, whereas anterior positioning better preserved sagittal alignment without compromising coronal correction or short-term clinical outcomes.
Objective: This study aimed to investigate changes in activity levels and health-related quality of life (HRQoL) in children with spastic cerebral palsy (CP) before and after botulinum toxin (BTX) injection, based on parental reports within the International Classification of Functioning Disability and Health (ICF) framework. Methods: This retrospective study included 60 children with spastic CP (20 girls, 40 boys) who underwent BTX injection for spasticity management. The age range was 2-11 years (mean age, 5.44 Å} 2.09 years). Gross motor function level was classified using the Gross Motor Function Classification System–Family Report. Activity was evaluated with the Pediatric Outcome Data Collection Instrumen (PODCI), and HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL) before and after BTX injection. Parents completed all questionnaires 6-12 months after BTX injection; pre- and post-injection scores were compared. Results: The PODCI scores improved significantly after BTX in upper extremity function (P = .001), transfers/basic mobility (P = .005), pain/comfort (P = .009), happiness/satisfaction (P < .001), and global score (P < .001), while the physical function/sports subscale did not change significantly (P = .136). The PedsQL total score improved (P < .001), with significant improvements in daily activities (P < .001), school (P = .034), activity/balance (P < .001), pain/ache (P = .015), fatigue/prostration (P = .002), and nutrition (P = .027); the speech/communication domain showed no significant change (P = .150). Conclusion: From a parental perspective, BTX injection was associated with improved activity and HRQoL in children with spastic CP, with gains seen across multiple functional and well-being domains. Clinically, these findings support counseling families that BTX within an ICF-oriented rehabilitation approach may translate into meaningful improvements in daily function and overall well-being, although speech-related outcomes may be less responsive. Cite this article as: Yavuz GK, Yılmaz G, Günel MK. Parent-reported activity and health-related quality of life after botulinum toxin in spastic cerebral palsy. Acta Orthop Traumatol Turc., 2026; 60(2), 0612, doi: 10.5152/j.aott.2026.25612.
Objective: This study aimed to evaluate the long-term functional and kinematic outcomes of patients with developmental dysplasia of the hip (DDH) who underwent Pemberton osteotomy (PO) during childhood and to compare their adult hip motion, muscle strength, and gait characteristics with those of healthy controls. Methods: This retrospective cross-sectional study included 12 adult patients (mean age 18.6 years) who underwent PO for DDH (6 bilateral, 6 unilateral) and 15 healthy controls (mean age 17.1 years). Hip range of motion (ROM), Harris Hip Score (HHS), and isokinetic muscle strength were evaluated. Three-dimensional gait and running analyses were performed using a motion capture system at 3, 6, and 9 km/h. Results: Mean HHSs were 92.8 Å} 4.2 and 92.7 Å} 5.1 in the bilateral and unilateral groups, respectively, and 100 in controls (P < .001). Hip ROM showed no significant inter- or intra-group differences. Isokinetic testing revealed reduced hip flexion total work in the bilateral (116 Å} 114 J) and unilateral (181 Å} 42 J) groups compared with controls (340 Å} 143 J; P = .007). Similarly, abduction strength in the bilateral group (75 Å} 52 J) was lower than in controls (143 Å} 73 J; P < .05). During slow walking (3 km/h), the unilateral group had a shorter stance time (0.30-0.32 s) than the healthy group (P < .01), while gait symmetry was comparable across all groups during fast walking and running. Conclusion: Patients who underwent early PO and appropriate rehabilitation achieved normal gait and running kinematics in adulthood despite mild flexion and abduction strength deficits. These findings demonstrate successful long-term adaptation and highlight the importance of timely surgical correction in DDH for preserving functional capacity. Cite this article as: Demirci A, Karabak B, Hoyur FY, Dzhumukov A, Aydın A, Karsan O. Adult gait kinematics and muscle strength after childhood Pemberton osteotomy for developmental dysplasia of the hip. Acta Orthop Traumatol Turc., 2026, 60(2), 0538, doi: 10.5152/j.aott.2025.25538.
