Anterior inferior glenoid rim fractures classified as Ideberg type Ia often combine shoulder dislocation, persistent instability and pain, impairing daily shoulder function. Traditional open surgery carries high risks of nerve injury and joint stiffness, while existing arthroscopic fixation methods have limitations for comminuted bone fragments. This study aimed to evaluate the clinical efficacy of arthroscopic reduction and single anchor fixation placed at the two o’clock glenoid position for Ideberg type Ia glenoid fractures, and compare recovery outcomes between patients with isolated fracture repair and those receiving one-stage combined rotator cuff repair. This single-center retrospective observational study enrolled 13 eligible patients treated with the above arthroscopic technique from 2019 to 2021. Preoperative and postoperative computed tomography scans were used to assess fracture reduction and bone healing. All patients completed standardized follow-up with measurements of shoulder active motion, abduction muscle strength and three shoulder functional scoring systems. Patients were divided into two subgroups based on concurrent rotator cuff tears. Paired t-tests analyzed pre- and post-operative indicators, independent samples t-tests compared subgroup outcomes, and intraclass correlation coefficients evaluated measurement reliability. Patients were followed up for (27.77 ± 4.75) months. Postoperative fracture displacement was significantly reduced, and all fractures achieved full healing within six months without major complications. Final follow-up shoulder motion and abduction strength were comparable to the uninjured contralateral shoulder, with all functional scores showing dramatic, statistically significant improvements. Inter-observer reliability of functional assessments was excellent. Subgroup comparison found no meaningful differences in shoulder motion, muscle strength or functional scores between patients with and without simultaneous rotator cuff repair. Arthroscopic two-o’clock single anchor fixation is a safe, minimally invasive treatment for Ideberg type Ia glenoid fractures, especially suitable for comminuted fractures. This technique reduces implant consumption, shortens operation time and lowers surgical costs. Concurrent rotator cuff injuries can be repaired in a single arthroscopic session without sacrificing shoulder strength or functional recovery, supporting wide clinical application of this combined minimally invasive strategy.
Pain and depression frequently co-occur in knee osteoarthritis (OA), traditionally viewed as a vicious cycle in which each worsens the other over time. However, conventional cross-lagged models cannot separate stable differences between individuals from real year-to-year changes within a person. We therefore used a random-intercept cross-lagged panel model (RI-CLPM) in the Osteoarthritis Initiative (OAI). Of 4,796 enrolled OAI participants with, or at risk of, knee OA, 4,638 contributed data across four annual waves from months 12 to 48. The RI-CLPM was applied to knee pain (WOMAC scale, worse knee) and depressive symptoms (CES-D scale), using full-information maximum likelihood. We contrasted it with a traditional model (CLPM), replicated it in a later six-wave window (months 36 to 96), and tested moderation by sex, arthritis severity, baseline pain and baseline depression, alongside covariate-adjusted and sensitivity analyses. Sensitivity analyses used a cognitive–affective CES-D subscale excluding somatic items, alternative model constraints and an alternative standardisation. The RI-CLPM fitted well and the between-person trait correlation was substantial (standardised r = 0.39, p < 0.001), whereas within-person cross-lagged paths were small and non-significant in both directions (pain to depression standardised beta = 0.019, 95
Complex pelvic and spinopelvic injuries present significant surgical challenges, often requiring intricate reduction and stabilization. Minimally invasive techniques reduce soft-tissue complications but are technically demanding. This study evaluates the safety, feasibility, and outcomes of using robotic-assisted navigation for spinopelvic fixation in complex trauma and presents our workflow and technique for these cases. A retrospective review was conducted of patients who underwent robotic-assisted spinopelvic fixation for traumatic pelvic and spinopelvic injuries at a single tertiary center. Outcome measures included reduction adequacy, operative time, radiation exposure, hardware failure, and postoperative complications. Sixteen patients (81
Humeral shaft nonunion is a challenging problem in orthopedic trauma. There is controversy regarding the choice between double-plate fixation and locking plate combined with structural bone grafting in the treatment of humeral shaft nonunion. This study aims to retrospectively compare the clinical advantages of double-plate fixation with autogenous iliac cancellous bone grafting (DPF group) versus locking compression plate anchored monocortical autogenous iliac bone and cancellous bone grafting (LCP + MAI group) in the treatment of humeral shaft nonunion. A total of 27 patients (10 females, 17 males) with closed, aseptic humeral shaft nonunion underwent revision surgery. The patients ranged in age from 29 to 55 years (mean 48 years). Fourteen patients were treated with double-plate fixation combined with autogenous iliac cancellous bone grafting (DPF group), and 13 patients were treated with locking compression plate fixation combined with monocortical autogenous iliac strut and cancellous bone grafting (LCP + MAI group). Operative time, intraoperative fluoroscopy frequency, fracture healing time, full weight-bearing time, and Disabilities of the Arm, Shoulder and Hand (DASH) scores of preoperative, 6-month and 12-month postoperative were collected for both groups. Direct medical costs of the two groups were also extracted from the hospital billing database and analyzed. Fracture healing was achieved in all patients in both groups. Operative time in the LCP + MAI group was 113.0 (IQR, 107.0-128.0) min, significantly shorter than 132.5(IQR,122.0-147.0) min in the DPF group (P<0.01). The number of intraoperative fluoroscopy exposures was 6.0 (IQR,6.0-6.0) in the LCP + MAI group, significantly lower than 8.0 (IQR,6.0-8.0) in the DPF group (P<0.05). No statistically significant differences were observed between the DPF and LCP + MAI groups in full weight-bearing time (p>0.05) or fracture healing time (p>0.05). There were no significant differences in preoperative DASH scores, DASH scores of 6-month and 12-month postoperative between the two groups (p>0.05). In the DPF group, the DASH scores improved significantly from 73.0 (IQR, 72.0-74.0) preoperatively to 30.5 (IQR, 29.0-32.0) at the 6-month follow-up and to 19.0 (IQR,18.0-20.0) at the 12-month follow-up (p<0.001). In the LCP + MAI group, DASH scores improved significantly from 74.0 (IQR,73.0-74.0) preoperatively to 31.0 (IQR,31.0-34.0) at the 6-month follow-up and to 19.0 (IQR, 18.0-20.0) at the 12-month follow-up (p<0.001). Medical costs analysis of the two treatment modalities demonstrated that Hardware costs (USD 3894.79 [2277.31, 4068.27] vs. 1672.62 [1453.20, 2332.89], p < 0.001), In-hospital costs (USD 7283.20±1183.27 vs. 4935.62±821.97, p < 0.001), and Total medical costs (USD 7476.65±1177.86 vs. 5124.50±5523.6, p < 0.001) were significantly higher in DPF group than in LCP + MAI group. The LCP + MAI technique offers comparable clinical efficacy to DPF, while demonstrating advantages in operative efficiency (shorter surgical time and fewer fluoroscopic exposures) and cost-effectiveness (lower total medical costs).
Lateral epicondylitis (LE) is a degenerative tendinopathy of the common extensor origin (CEO). Although local glucocorticoid injections are widely used for symptom relief, concerns exist regarding their potential adverse effects on tendon structure. This study aimed to investigate the association between prior glucocorticoid injection and magnetic resonance imaging (MRI)-based structural CEO damage in patients with chronic LE. In this retrospective, multicenter cross-sectional study, 147 patients with clinically diagnosed LE (symptom duration ≥ 6 months) who underwent elbow MRI between 2015 and 2023 were included. The primary exposure was prior local glucocorticoid injection at the CEO (yes/no and number of injections). Structural tendon damage was assessed using the Walz classification and quantitative lesion size diameters measured in coronal, axial, and sagittal MRI planes. Associations were analyzed using proportional odds ordinal logistic regression and generalized linear models, adjusted for age, sex, occupational workload, study center, and symptom duration. Sixty-three patients (42.9
Sarcopenia is a progressive skeletal muscle disorder characterized by loss of mass, strength, and function. However, reliable molecular biomarkers for early detection remain limited. This study aimed to identify and validate potential biomarkers for sarcopenia through a combination of machine learning analysis and experimental validation. Differential expression analysis between sarcopenia and control samples was performed using the GSE1428 dataset. Three machine learning algorithms were applied to screen candidate hub genes, and the diagnostic performance was evaluated by receiver operating characteristic curve analysis. Candidate gene expression was further validated in independent clinical samples using quantitative real‑time PCR (qRT‑PCR), Western blotting, and immunohistochemistry. Functional analyses were conducted to explore the underlying mechanisms. A total of 39 differentially expressed genes were identified. The intersection of machine learning algorithms identified four hub genes: C1QA, COL21A1, SLC38A1, and HOXB2. All four genes showed good diagnostic accuracy, with COL21A1 achieving an area under the curve value of 0.967. Clinical validation by qRT‑PCR showed that among the four hub genes, only COL21A1 was significantly upregulated at the mRNA level in sarcopenia samples compared with controls. Western blot confirmed that COL21A1 protein expression was significantly increased in sarcopenia. Immunohistochemistry showed enhanced cytoplasmic and extracellular matrix staining in sarcopenic samples. Functional analyses indicated significant associations between COL21A1 expression and immune‑related pathways. This study identified and validated COL21A1 as a potential candidate biomarker for sarcopenia. These findings offer new molecular insights for sarcopenia and may suggest a candidate biomarker for future therapeutic investigation.
The objective of this retrospective study was to evaluate the impact of bone involvement or erosion in localized TGCT of the fingers on local recurrence rates subsequent to surgical excision. The 85 patients who underwent surgical treatment were monitored clinically and radiologically for an average duration of 64.32 ± 53.85 months. Magnetic resonance imaging (MRI) examinations were conducted on patients exhibiting indications of recurrence. Numerical Pain Rating Scale (NPRS) and Michigan Hand Outcome Survey (MHOS) were assessed and statistically analyzed. The mean age was 42.27 ± 15.75. Female patients were predominant (67.1
To investigate whether unilateral cervical facet nerve blockade (FNB) is associated with changes in head repositioning accuracy (HRA), shoulder joint relocation accuracy (JRA), and standing balance in patients with chronic neck pain. This retrospective single-center interventional study included 99 patients treated at the Department of Physical Medicine and Rehabilitation. Cervical proprioception (HRA), shoulder proprioception (JRA), and standing balance (computerized posturography) were assessed before the intervention, immediately after FNB, and at 1-month follow-up. Because normal distribution could not be assumed, non-parametric tests were applied (Mann–Whitney U for independent comparisons and Wilcoxon signed-rank test for paired comparisons). Cervical proprioception during sagittal movements improved significantly after FNB, with effects maintained at 1-month follow-up. The most consistent improvement was observed for HRA during flexion (p < 0.001). Shoulder JRA during abduction also improved significantly after FNB (p = 0.002–0.02), and the improvement persisted at follow-up on the right side. Differences in JRA were observed between patients with upper versus lower cervical dysfunction, with lower cervical dysfunction showing a greater impact on shoulder relocation accuracy. Postural performance improved after FNB, particularly for trace length in the Romberg test (p = 0.02–0.002), and improvements were sustained at follow-up. Patients with higher baseline postural sway demonstrated greater balance improvements than those with low baseline sway. Significant correlations were observed between postural performance and HRA/JRA measures. Secondary outcomes showed significant improvement at 1-month follow-up in neck pain (p < 0.001), health-related quality of life (EQ-5D) (p = 0.005), and disability (Oswestry Disability Index) (< 0.001). Unilateral cervical FNB was associated with improvements in cervical repositioning accuracy, shoulder abduction relocation accuracy, and postural performance, with effects persisting at 1-month follow-up. Improvements were also observed in pain, health-related quality of life, and disability. Given the retrospective single-arm design and single-center setting, these findings should be interpreted as preliminary and require confirmation in prospective controlled studies.
Pin tract infection (PTI) is one of the most frequent complications of external fixation and can lead to pain, osteolysis, loss of fixation, and prolonged treatment. Although several studies have described prognostic variables for PTI, no validated prognostic models or risk scores are currently available to estimate individual patient risk. Socioeconomic and behavioral factors may influence hygiene routines, access to antiseptics, and adherence to care instructions, yet these variables are rarely incorporated into models that may help identify patients at higher risk. This study aimed to develop a preliminary prognostic risk score for PTI in patients treated with external fixation using socioeconomic, behavioral, and clinical prognostic variables. Among 1,220 patients admitted with traumatic limb fractures, 417 required surgical stabilization. External fixation was commonly used for tibial fractures. A total of 119 patients with external fixators attended follow-up visits and agreed to participate in interviews. Four were excluded (one aged < 18 years, one with an upper extremity fixator, and two with congenital deformities), resulting in a final sample of 115 adults treated with standard external fixation for ≥ 2 weeks. Interviews were conducted during routine follow-up visits over a two-year period. The primary outcome was PTI, defined as erythema, secretion, and pain requiring topical or oral antibiotics (Checketts–Otterburn Grade 2). Secondary variables included socioeconomic and behavioral factors such as smoking, alcohol consumption, diet, education level, and hygiene practices. Candidate prognostic variables were evaluated using Cox proportional hazards regression and combined into a preliminary prognostic risk score. Discrimination of the prognostic model was assessed using time-dependent area under the receiver operating characteristic curve (AUC). Among 115 patients (mean age 39 ± 14.5 years; 83
Bilateral medial compartment knee osteoarthritis with varus alignment may be treated with staged or simultaneous medial opening wedge high tibial osteotomy (MOWHTO). Simultaneous bilateral MOWHTO may reduce the overall rehabilitation burden, but concerns remain regarding complications, early mobility, and return to work. This study evaluated adverse events, radiographic correction, functional recovery, and return to work after simultaneous bilateral MOWHTO with early weight bearing. A retrospective case series was performed of 15 patients who underwent simultaneous bilateral MOWHTO between January 2002 and December 2023 at a single specialist sports medicine centre. Demographic, operative, radiographic, complication, mobility, return-to-work, hardware removal, and conversion-to-total-knee-arthroplasty data were extracted from medical records and imaging. Adverse events were classified using the Martin et al. framework (Class I–III). Fifteen patients underwent 30 osteotomies. Mean age was 50 years, and minimum follow-up was 18 months. Mean operative time was 107 min, mean hospital stay was 4.5 days, and mean osteotomy opening was 12.0 mm. Mean hip-knee-ankle angle improved from 169.8° pre-operatively to 180.9° post-operatively. Radiographic union was confirmed at the 6 month radiograph in 28 knees and at the 9 month radiograph in 2 knees. Three undisplaced lateral hinge fractures and 2 delayed unions occurred, all resolving without surgical intervention. Two superficial infections resolved with oral antibiotics and local wound care. There were no Class III adverse events, deep infections, thromboembolic events, cardiac events, hardware failures, losses of correction, or reoperations. All patients discontinued mobility aids by 12 weeks. Among 9 patients employed pre-operatively, 8 returned to work at a mean of 165.1 days. Simultaneous bilateral MOWHTO with early weight bearing was associated with low serious adverse event rates, reliable radiographic union, early functional recovery, and high return to work. These findings support simultaneous bilateral MOWHTO as an effective option for patients seeking a single operative and rehabilitation episode.
Proprioceptive deficits and impaired scapular control are increasingly recognized in adolescents with idiopathic scoliosis (AIS), yet whether targeted sensorimotor interventions provide benefits beyond conventional rehabilitation remains unclear. This study aimed to evaluate the additional effects of proprioceptive neuromuscular facilitation (PNF) on shoulder proprioception, scapular control, and global functional outcomes in AIS. In this assessor-blinded randomized controlled trial, 46 adolescents with AIS were randomly allocated to the PNF plus conventional rehabilitation group or the conventional rehabilitation group. Outcome assessments were conducted at baseline and after an 8-week intervention. Thirty-seven participants (PNF group, n = 19; control group, n = 18) completed the 8-week intervention and post-intervention assessments and were included in the per-protocol analysis. Primary outcomes included shoulder joint position sense assessed by the active reposition test (ART) and scapular postural control measured by scapular balance angle (SBA). Secondary outcomes included lateral scapular slide test (LSST), surface electromyography (sEMG), postural parameters, angle of trunk rotation (ATR), and health-related quality of life (SC-SRS-22). Between-group and within-group differences were analyzed using parametric or non-parametric tests according to data distribution. Both groups demonstrated improvements in selected postural and functional parameters after intervention. However, the PNF group showed significantly greater improvements in ART at medium and high target angles compared with the control group (p < 0.05), along with superior reductions in SBA and LSST (0° position). Significant normalization of sEMG-based muscle activation symmetry was observed in the upper trapezius, lower trapezius, and infraspinatus muscles in the PNF group. In contrast, no between-group differences were found in ATR or SC-SRS-22 scores. Notably, improvements in scapular alignment and trunk rotation were not accompanied by parallel recovery of proprioception in the control group, indicating a dissociation between structural and sensorimotor adaptations. PNF provides additional benefits in shoulder proprioception and scapular neuromuscular control beyond conventional rehabilitation in AIS. However, these improvements do not translate into short-term changes in trunk rotation or health-related quality of life. These findings suggest that scapular proprioception represents a distinct, modifiable neuromuscular domain in AIS that may require targeted intervention independent of global postural correction. ChiCTR2500099252, Date: 2025-03-20.
Three current consensus definitions for sarcopenia—EWGSOP2 (2019), AWGS2 (2019), and SDOC (2020)—differ substantially in their conceptual framework and operational cutoffs. No published meta-analysis has quantitatively pooled prognostic estimates across all three criteria. We aimed to compare pooled prevalence and prognostic associations with all-cause mortality and hospitalisation across these three definitions. We conducted a PRISMA 2020-compliant systematic review with searches in PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, and Wanfang from 1 January 2019 to 31 May 2026. Eligible studies enrolled adults in any setting (Population), applied EWGSOP2, AWGS2, or SDOC exactly as published (Index/Comparator constructs), and reported sarcopenia prevalence or adjusted associations with all-cause mortality or hospitalisation (Outcomes). Risk of bias was assessed with the JBI checklist (prevalence studies) and ROBINS-E (cohort studies). Random-effects meta-analysis used Freeman–Tukey transformation for prevalence and generic inverse variance with Hartung–Knapp adjustment for hazard ratios; subgroup, meta-regression, within-cohort indirect comparison, leave-one-out, and Egger publication-bias analyses were pre-specified, whereas meta-regression was exploratory. Pooled prevalence was 11.3
This study aimed to comparatively investigate the relationships between the ultrasonographic architectural and viscoelastic properties of the soleus, medial gastrocnemius (MG), and rectus femoris (RF) muscles and objectively measured aerobic capacity in healthy young adult males. This observational cross-sectional study included 59 healthy male medical students aged 18–30 years. The muscle thickness, pennation angle, fascicle length, and shear wave elastography (SWE) stiffness of the right lower-extremity RF, MG, and soleus were measured ultrasonographically. Aerobic capacity was evaluated using cardiopulmonary exercise testing (CPET) with the Bruce protocol, and VO₂max was recorded as the primary outcome. Participants were stratified into low- and high-aerobic capacity groups based on the median VO₂max value (29.4 mL·kg⁻¹·min⁻¹). Associations were examined using correlation analysis and multiple linear regression. No significant between-group differences were observed in any ultrasonographic or SWE parameter (low vs. high aerobic capacity groups). Conventional architectural parameters (muscle thickness, pennation angle, and fascicle length) showed no significant correlations with VO₂max across all assessed muscles. RF SWE velocity demonstrated a significant positive correlation with VO₂max (r = 0.364, p = 0.005), designated a priori as the primary comparison; RF Young’s modulus showed a smaller, exploratory correlation (r = 0.274, p = 0.036) that did not survive multiplicity correction, and no soleus or MG SWE parameters correlated with aerobic capacity. In multiple linear regression analysis, RF SWE velocity (β = 0.280, p = 0.021) and BMI (β=−0.555, p < 0.001) were independently associated with VO₂max (R²=0.310). RF shear wave velocity is independently associated with aerobic capacity (VO₂max) in healthy young men, whereas no significant association was detected for the soleus or MG. These associations were not formally compared between muscles.
Anterior cruciate ligament injury represents a significant challenge in professional football, frequently leading to prolonged rehabilitation and uncertainty regarding players’ return to play performance. Although a majority of players ultimately resume competition following ACL reconstruction, existing studies report considerable variability in return-to-play rates and time required to return. Accordingly, this systematic review and meta-analysis synthesizes current evidence on return-to-play outcomes after ACL reconstruction by distinguishing return to training from return to official match play and exploring differences according to treatment modality and sex. We systematically searched five databases through November 13, 2025, including studies on professional football players who underwent anterior cruciate ligament reconstruction surgery, reporting their return-to-play rates and recovery time. The pooled return-to-play proportion was estimated using a random-effects model with logit transformation. Between-study heterogeneity was explored through subgroup analyses. Study quality was evaluated using the Newcastle–Ottawa Scale, while potential publication bias was examined by visual inspection of funnel plots and Egger’s regression test. Twenty studies involving 1,992 professional football players were included. The pooled return-to-sport rate after ACL reconstruction was 92
Although discoblock and percutaneous vertebroplasty (PVP) have certain therapeutic effects for the management of painful Schmorl’s Nodes (SNs), unfortunately, there is no comparative study to focus on the effectiveness of the two methods. The aim of the study is to analyze the efficacy of discography and discoblock versus PVP in the treatment of painful SNs. We analyzed the clinical and radiographic records of consecutive patients with LBP associated with painful SNs, who had undergone discography and discoblock or PVP between June 2015 and August 2022. Seventy-four patients were enrolled (Discoblock group: 40 cases; PVP group: 34 cases). Perioperative parameters, Visual Analogue Scale (VAS) scores, The Oswestry Disability Index (ODI) and recurrence rate were compared between the two groups. Compared with the PVP group, the discoblock group showed no significant difference in hospital stay (P > 0.05), all patients were discharged the next day after surgery. However, the discoblock group had advantages in operation time and average incision length(P < 0.05). Thirty-six (36/40) patients reported immediate improvement of their LBP after discoblock, and none reported worsening of their symptoms. All patients reported immediate improvement of their LBP after PVP. On the 24 h, 1 month, 3 months, and 12 months after surgery, both groups showed significant improvement in VAS scores and ODI compared with preoperative. There were no significant differences in VAS scores and ODI within each group at postoperative 1 day, 1 month, 3 months, and 12 months (P > 0.05). There were no significant differences in ODI index and VAS between the two groups at 12 months postoperatively. None of the patients undergoing the discography/discoblock and PVP procedures developed intra-, peri-, or post procedure complications. No allergy or infection could be observed. Ten (10/36) patients had reoccurring pain after discoblock, six patients underwent OLIF, with or without posterior pedicle screw-rod instrumentations, two patients underwent PVP, and two patients choose conservative treatment. No patients had reoccurring pain after PVP. Discoblock and PVP are both safe, minimally invasive procedures that proved effective for rapid symptom relief. PVP exhibited a significantly lower recurrence rate, indicating its clinical advantage in long-term outcomes.
Critical-size bone defects remain a formidable challenge in orthopaedic surgery. Biodegradable polymer scaffolds represent a promising alternative to autologous bone grafting, but conventional polylactic acid (PLA) scaffolds exhibit limited osteoconductivity and generate acidic degradation products unfavorable to bone healing. Incorporation of nanoclay particles into PLA matrices may overcome these limitations. This study evaluated a novel PLA/nanoclay (NK-75) biodegradable composite scaffold for healing a 3 mm extraperiosteal mid-diaphyseal segmental defect in a rabbit ulnar model. Six skeletally mature New Zealand White rabbits underwent mid-diaphyseal ulnar osteotomy creating 3 mm extraperiosteal segmental defects (three bilateral and three unilateral procedures, yielding nine operated ulnae in total). Treatment assignment to a given limb was decided intraoperatively. Each ulna underwent serial radiographic assessment at successive post-operative weeks (4, 8, 12, 16, 20) up to and including the week of sacrifice, with the Lane–Sandhu score recorded at each time point. This longitudinal design yielded 30 radiographic Lane–Sandhu observations across the cohort, distributed as PLA + NK-75 (n = 15), PLA-only (n = 4) and untreated empty defect (n = 11). All anteroposterior radiographs were independently scored by two assessors from the orthopaedic team and the arithmetic mean of the two scores was used. Histological sections were independently reviewed by two histopathologists blinded to treatment allocation. Radiological healing was assessed using the Lane–Sandhu scoring system (total score 0–10, comprising bone formation, proximal union, distal union and remodeling). Data were analysed using Kruskal–Wallis test with Dunn’s post-hoc comparisons, Mann–Whitney U test, linear mixed models and generalised estimating equations (with Animal ID as the random/clustering unit to account for the longitudinal repeated-measures and bilateral within-animal correlation structure), ordinal logistic regression and permutation tests. Effect sizes and post-hoc power were calculated. Given the small PLA-only group, the PLA vs. PLA + NK-75 contrast was treated as exploratory. The PLA + NK-75 group demonstrated significantly higher mean total Lane-Sandhu scores (7.20 ± 1.93) compared to PLA (4.75 ± 3.59) and control (4.00 ± 2.32; Kruskal-Wallis p = 0.0144). Post-hoc analysis confirmed PLA + NK-75 superiority over control (Dunn’s p = 0.0062; Mann-Whitney p = 0.0044). Large effect sizes were observed (Hedges’ g = 1.47; Cliff’s delta = 0.66). The probability that a randomly selected PLA + NK-75 observation exceeds a control observation was 83.0
The optimal fixation strategy for displaced three- and four-part proximal humerus fractures remains controversial. This study compared clinical, radiological and functional outcomes after locking plate osteosynthesis versus external fixation in adult Neer three- and four-part proximal humerus fractures. This single-center retrospective comparative cohort study included 68 adult patients who underwent surgery between January 2012 and December 2020. Thirty-seven patients were treated with locking plate osteosynthesis and 31 with external fixation. Fractures were classified according to Neer and AO/OTA systems. Final follow-up assessment included union time, complications, revision surgery, range of motion, Constant-Murley, ASES, UCLA and DASH scores. A multivariable linear regression model was used to examine Constant-Murley score after adjustment for treatment group, fracture severity, age, sex, comorbidity and follow-up duration. The cohort comprised 33 women and 35 men, with a mean age of 51.8 years. Baseline characteristics are presented by treatment group; age, comorbidity prevalence and follow-up duration differed between groups. The multivariable model was statistically significant and explained 56.3
This study evaluates the effects of an 8-week Dynamic Neuromuscular Stabilization (DNS) program on disability, physical activity, and fear-avoidance behaviors in postoperative lumbar disc herniation (LDH) patients. The study was designed as a randomized controlled trial. Participants of both sexes, aged 35–50 years, were recruited from a single-center postoperative outpatient physiotherapy setting and randomized into DNS (intervention) and standard care (control) groups. The DNS program emphasized core stability, diaphragmatic breathing, and postural alignment. Outcomes were measured at baseline and after the 8-week intervention period using validated scales for disability (ODI), pain (VAS), physical activity (MET-minutes), and fear-avoidance (FDAQ). Data were analyzed using appropriate inferential statistical methods, with statistical significance set at p < 0.05. Baseline characteristics were comparable between groups (p > 0.05). Post-intervention, a significant difference was observed between groups in physical activity level categories (p = 0.001), with a shift toward higher activity levels in the intervention group. Physical activity (MET-min/week) was significantly higher in the intervention group at post-intervention (p = 0.001). Post-intervention, the intervention group demonstrated significantly lower functional disability, pain at rest, pain during activity, and fear of daily activities compared to the control group (all p ≤ 0.001). Within-group analyses showed significant improvements in functional disability, pain, fear of daily activities, and physical activity in the intervention group (all p < 0.001). DNS demonstrated superior efficacy compared to standard care, achieving clinically meaningful improvements across all metrics. These results highlight DNS as a promising approach for enhancing functional recovery and clinical outcomes in patients with LDH. The protocol is registered with http://clinicaltrials.gov/15/August/2023, Clinical Trial, NCT06005948).
A cross-sectional study was performed to compare the cortical femoral shaft between the leg with knee hemophilic arthropathy and the contralateral leg. Children with hemophilic arthropathy were included. Joint evaluation was made using the Hemophilia Joint Health Score 2.1 (HJHS 2.1) and the Functional Independence Score in Hemophilia (FISH). The cortical femoral shaft in each leg was assessed in three parts (upper, middle, and lower thirds) using computed tomography to evaluate thickness and density in eight different sectors. Thirty children were evaluated; mean age was 12 ± 2 years old. The HJHS score between knees was 6.5 ± 3.8 vs. 2.3 ± 3.0 (p = 0.003). When comparing the cortical thickness, statistically significant differences were noted for the upper third sector: lateral, anterolateral, and posterolateral, meanwhile for the lower third: posterior, anteroposterior, posteromedial, and anteromedial sectors, being thinner in the femur with knee hemophilic arthropathy. When comparing the cortical densities, differences were noted for the upper third sector: anterior, medial and posteromedial, as well as in the middle third: lateral, anteromedial, and posterolateral sectors (p = 0.000). We observed a thinner and less dense cortical femoral shaft in the leg with knee hemophilic arthropathy, predominately in the upper and lower third sections. Changes noticed in the affected femur with knee arthropathy likely reflect a reduced cortical bone expansion related to impaired kinematics and loading forces on the affected knee during normal walking and running.
Robotic knee arthroplasty has shifted attention from whether a surgical plan can be executed accurately to which plan should be selected for each patient. This Collection examines robotic platforms, alignment strategies, safety, outcomes, and the evidence needed to translate technical precision into meaningful clinical benefit.
