Hip fractures in elderly patients present significant challenges to healthcare systems. The direct anterior approach (DAA) has shown advantages in total hip arthroplasty (THA) with regards to blood loss, postoperative mobilization, and hospital stay. How these potential benefits translate to outcomes in hemiarthroplasty (HHA), specifically for elderly and often frail patients with hip fractures, remains unclear. This study investigates whether the DAA associates with lower 1-year mortality rates in this fragile population compared with conventional surgical approaches for HHA. We emulated a target trial using data from the Dutch Arthroplasty Register (LROI). Patients aged ≥ 75 years undergoing HHA (2007–2021) for hip fractures were included. Propensity score matching was used to create comparable treatment arms based on surgical approach: DAA, posterolateral (PLA), anterolateral (ALA), and straight lateral (SLA). Primary outcome was 1-year mortality. Secondary outcomes included the prevalence of the analyzed surgical approaches over time. Statistical analyses were done with Cox proportional hazard models and illustrated by Kaplan–Meier survival curves. Overall, 40,981 eligible patients were included. In this population, the proportion of DAA for HHA increased from 0
To investigate the surgical technique and therapeutic effect of autologous costochondral transplantation (ACT) in patients with Hepple V osteochondral lesions of the talus (OLT) and to compare both methods with osteoperiosteum transplantation (OPT). Clinical data from 53 patients (53 ankles) with Hepple V OLT admitted to Shanghai Jiao Tong University School of Medicine Affiliated Sixth People’s Hospital between February 2020 and February 2022 were retrospectively analyzed, including 27 ankles treated with ACT and 26 with OPT. General information, operative time, and hospitalization duration were recorded. Preoperative and final follow-up assessments used the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale (FAAM-ADL) and sports subscale (FAAM-Sp), the EuroQol-Visual Analogue Scale (EQ VAS), and the Magnetic Resonance Observation of Cartilage Repair Tissue 2.0 (MOCART 2.0) to evaluate efficacy and function, verify whether clinical satisfaction with ACT exceeded that of OPT, and document related complications during follow-up. No statistically significant differences in baseline characteristics and scores were observed between the two groups preoperatively. At final follow-up, FAAM-ADL, FAAM-Sp, and EQ VAS scores in both groups were significantly higher than preoperative values (P < 0.05). The mean MOCART 2.0 scores in the ACT group at final follow-up showed significant improvement compared with 12 months postoperatively (P < 0.05), whereas no such difference was observed in the OPT group. Postoperative scores at each follow-up point favored the ACT group over the OPT group. Three patients (11.1
Abstract Background Orthopaedics, as a surgical speciality with a structurally narrower citing audience and lower citation density than general medicine, is systematically disadvantaged in any cross-disciplinary comparison relying on absolute citation counts. Whether this disadvantage is stable or has changed over time has not been previously quantified. Methods The 100 most-cited articles indexed in the Web of Science Core Collection were identified for medicine and orthopaedics in 2014 and 2024. Citation data were extracted from a single snapshot taken on 19 January 2026. Total citations and citation velocity, defined as citations per year since publication, were compared between fields and across time points using Mann-Whitney U tests. Ratio-based analyses and distributional characteristics were also assessed. Results Median citation counts were substantially higher in medicine than in orthopaedics in both years, reaching 5055 versus 288 in 2014 and 720.5 versus 34.0 in 2024, corresponding to 17.6- and 21.2-fold differences, respectively. Citation velocity followed the same pattern, with medicine maintaining an approximately 17- to 21-fold advantage at both time points. Within-field temporal analysis showed that citation velocity remained broadly stable in medicine between cohorts, whilst orthopaedics demonstrated reduced early citation accrual in the more recent cohort. Citation distributions were more right-skewed in medicine, with a small number of articles accounting for a disproportionate share of total citations, whereas orthopaedic citations were more evenly distributed across the top 100. Conclusions Orthopaedics demonstrated substantially lower citation performance than general medicine articles, and this gap appeared to persist over time.
Total knee arthroplasty (TKA) is a cornerstone intervention for end-stage knee pathologies, yet acute postoperative pain remains a critical barrier to rehabilitation. Transcutaneous electrical nerve stimulation (TENS), a non-pharmacological adjunct, has potential for pain mitigation, but its efficacy lacks robust evidence from umbrella reviews. This umbrella review systematically evaluated meta-analyses (MAs) published through September 2025 in PubMed/MEDLINE, Embase, the Cochrane Library, and Web of Science. Overlap among primary studies was assessed using the GROOVE tool, and evidence quality was graded via the AMSTAR 2 and GRADE frameworks. This umbrella review is registered on the Prospective Register of Systematic Reviews (PROSPERO) under accession no. CRD420251126630. Eleven MAs were included in this review. The results showed that TENS significantly reduced acute postoperative pain at 24 h (MD = − 0.42, 95
Given the differences between biopsy techniques, especially regarding the representativeness and amount of tissue obtained upon diagnostic workup of suspicious bone and soft tissue lesions, this study aimed at evaluating the diagnostic conclusiveness of different biopsy techniques at a tertiary sarcoma centre. Overall, 222 consecutive patients (50.9
Femoral fractures in children are uncommon and are usually trauma-related; however, some occur secondary to underlying bone pathology. Early differentiation between traumatic and pathological fractures is essential to avoid delayed diagnosis. This study aimed to identify clinical predictors associated with pathological femoral fractures in children. In this retrospective single-center comparative study, 432 pediatric patients (0–17 years) with femoral fractures were included. These fractures were classified as traumatic (n = 386, 89.4
Abstract Background Mental health disorders have become a growing global concern. Sleep quality is known to have a crucial impact on mental well-being. Poor sleep contributes to increasing economic costs owing to reduced productivity as well as the development of mental disorders. Conversely, anxiety and depression often lead to sleep disturbances. Pain is a key factor affecting sleep quality. Studies have shown that musculoskeletal disorders, especially in the shoulder, may cause sleep disturbances. Research on the relationship between elbow pain and sleep quality remains limited. This study aims to evaluate the impact of common elbow pathologies on sleep quality. Methods This prospective multicenter cohort study used self-reported outcome measures in patients with elbow disorders, including the Pittsburgh Sleep Quality Index (PSQI), to assess sleep quality. The PSQI was compared with other outcome measures. Results A total of 664 patients (284 female, 380 male) were included, of whom 81% reported nocturnal pain. The mean age was 47.9 ± 14.2 years, body mass index (BMI) 26.9 ± 6.7 kg/m 2 and symptom duration 15.8 ± 7.3 months. The most common diagnoses were lateral epicondylar pain (66%), medial epicondylar pain, arthritis, ulnar nerve entrapment and biceps/triceps tendinopathies. The overall PSQI was 7.3 ± 3.8, disabilities of arm, shoulder and hand questionnaire (DASH) 35.0 ± 19.8, sports/performing art module of disabilities of arm, shoulder and hand questionnaire (spa-DASH) 16.2 ± 13.8, work module of disabilities of arm, shoulder and hand questionnaire (w-DASH) 29.2 ± 15.8, single assessment numeric evaluation elbow (SANE-E) 54.9 ± 25.4 and numeric rate scale (NRS) 3.1 ± 2.7. No significant differences in other scores were observed between pathology subgroups. Correlation analysis showed a moderate association between PSQI and DASH score ( r = −0.372, p < 0.001), as well as between PSQI and NRS for pain ( r = 0.255, p = 0.002), while other variables showed no significant correlations. Conclusions Nocturnal pain and sleep disturbances are highly prevalent in patients with elbow disorders. Evaluating and addressing sleep quality may improve functional outcomes and overall well-being. Future research should investigate how different treatment modalities affect pain, function and sleep quality.
Whether the radiographic assessments of pediatric anatomical (A-HRJA) and nonanatomical humeroradial joint alignment (NA-HRJA) among pediatric orthopedic surgeons (POS) relies on clinical experience remains unknown. No vision transformer (ViT) model for automated and accurate radiographic pediatric HRJAs categorization has been developed and validated. This study aims to evaluate the radiographic assessment outcomes of pediatric A-HRJAs and NA-HRJAs among POS with varying levels of experience, and to develop and validate a model for automated and accurate categorization of pediatric HRJAs on radiographs. A total of 294 pediatric radiographs were independently recorded by four junior-level, four mid-level, and three senior-level POS. Then, the performance of the POS with various levels of experience was evaluated. A total of 5118 pediatric radiographs (2932 A-HRJAs and 2186 NA-HRJAs) were prepared to construct the vision transfer (ViT) model. The ViT model’s clinical efficacy was evaluated using an external testing dataset (84 A-HRJAs and 132 NA-HRJAs). A total of 11 POS independently recorded the HRJA types of the external testing dataset twice with a 1-month interval: first without ViT model assistance, and second with assistance. The rating performances of the POS without and with ViT model assistance were compared. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were similar among junior-level, mid-level, and senior-level POS (P > 0.050). The ViT model’s area under the receiver operating characteristic curve was 0.944. The ViT model’s rating performance was significantly superior to that of POS in the first round regarding accuracy (P = 0.001), sensitivity (P = 0.001), and NPV (P < 0.001). However, no significant differences were found between the ViT model and POS in the second round. The accuracy (P = 0.008), PPV (P = 0.043), and NPV (P = 0.030) improved significantly in the second round compared with the first, as demonstrated by the following values: 86.9–92.6
Fibrous dysplasia (FD) is a rare benign bone disease caused by postzygotic activating mutations in the GNAS gene, leading to replacement of normal bone with fibrous tissue. It may be monostotic or polyostotic, often asymptomatic but sometimes associated with pain, deformity, or fractures. Management is mainly surgical in symptomatic or complicated cases. This retrospective study analyzes a large FD cohort to identify determinants of treatment and outcomes, with a focus on pain and its evolution. The primary aim was to assess factors influencing surgical indication, while the secondary aim was to evaluate predictors of outcome in surgically treated patients, particularly symptom persistence at follow-up. A total of 227 patients were included. Mean age at diagnosis was 35.5 years (range 2–86 years); 79.3
Sepsis is a life-threatening complication in patients with orthopedic trauma, associated with significant mortality. Dysregulated glucose metabolism is a hallmark of critical illness, but the specific role of glycemic variability (GV), beyond hyperglycemia, in this high-risk population remains inadequately explored.Kindly check and confirm the author and their respective affiliations 9 and 10 are correctly identified.Some changes have been made. Please refer to the eProofing system. This retrospective cohort study utilized 1946 patients from the Beth Israel Deaconess Medical Center between 2008 and 2022. We included adult intensive care unit (ICU) patients with a primary diagnosis of orthopedic trauma and concurrent sepsis. GV was quantified as the coefficient of variation of all blood glucose measurements during the ICU stay. The primary outcome was all-cause mortality at in-hospital, 30-day, 90-day, and 365-day. Restricted cubic spline (RCS) analysis was used to determine the detailed relationship between GV and mortality and the optimal GV threshold for dichotomization. Propensity score matching and multivariable logistic regression were employed to control for confounders. The study cohort experienced substantial mortality, with rates of 16.0
The success of total knee arthroplasty (TKA) depends on achieving precise mechanical alignment and stable soft tissue balance, with the thickness of the final polyethylene (PE) insert serving as a critical component. However, the impact of preoperative factors on PE thickness remains unclear. In this study, we investigated the effects of preoperative knee alignment and clinical deformities on PE thickness. The medical records of patients who underwent primary TKA between August 2024 and July 2025 were retrospectively evaluated. Preoperative radiographic parameters, including the hip-knee-ankle (HKA) angle, medial proximal tibial angle, lateral distal femoral angle (LDFA), joint-line convergence angle, weight-bearing line ratio (WBLR), and posterior tibial slope, were measured, along with the flexion contracture (FC) as a clinical factor. Intra-observer reliability was assessed using intraclass correlation coefficients (ICC). Linear regression analyses were performed to evaluate the effects of these preoperative factors on PE thickness. This study included 233 knees (158 patients). The intra-observer reliability of the radiographic parameters was excellent (ICC > 0.9). Multivariable linear regression revealed that preoperative HKA angle (β = 0.033, p < 0.001), WBLR (β = −0.008, p < 0.001), and LDFA (β = 0.065, p = 0.003) were significantly associated with final PE thickness. Preoperative FC demonstrated a significant negative correlation (β = −0.027, p = 0.011). In a subgroup analysis of knees with minimal FC, the mean PE thickness increased from 10.37 mm in mild varus to 12.75 mm in extreme varus. Preoperative HKA angle and FC were identified as significant predictors of PE insert thickness in TKA. Specifically, greater varus deformity resulted in a thicker PE insert, whereas more severe FC led to a thinner insert. Clinically, surgeons must anticipate gap expansion after medial release in varus knees, while accommodating the tight extension space in the FC. Level of evidence Level III, retrospective comparative study.
Fibular allograft (FA) augmentation is proposed to address the lack of medial column support in plate-fixed proximal humeral fractures; however, the role of FA augmentation in these fractures remains inadequately elucidated. Our previous clinical trial did not show additional benefit in inserting an FA when treating adults with medial column comminuted proximal humeral fractures. Nonetheless, it is possible that some subgroups may still derive benefits from FA. This study aimed to investigate whether there were any subgroups benefit from FA. Our randomized controlled trial (RCT) recruited adults with a medial column comminuted proximal humeral fracture and randomly allocated them to receive a surgery fixed with a locking plate (LP group) or with an LP augmented with an FA (FA group). This study was a subsequent subgroup analysis of the previous randomized controlled trial, in which we included 72 participants who completed follow-up at the time of 12 months for the current subgroup analysis. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months postoperatively. The secondary outcomes included the DASH score at other time points, changes in neck-shaft angle and humeral head height. We used generalized linear models for subgroup analysis to evaluate the effect of intervention (FA or LP) on 12-month DASH score in subgroups. A total of 72 participants who completed follow-up at 12 months were included: 35 were in the FA group and 37 in the LP group. In participants with proximal humeral osteoporosis, both the unadjusted mean difference (−12.8; 95
The PediLoc® Locking Cannulated Blade Plate System was originally designed for proximal femoral osteotomies but has also been used for multidimensional correction of distal femoral deformities. The present study delineates the surgical technique and undertakes a retrospective analysis of the consolidation rates of distal femoral osteotomies performed using the aforementioned system, comparing them with those performed using the DePuy Synthes® 90° LCP Pediatric Condylar Plate. We hypothesized that the semi-rigid design of the blade plate results in faster osteotomy healing rates compared with other locking screw plate systems. This retrospective single-centre study included patients who underwent distal femoral osteotomy with the PediLoc® Blade Plate (Blade Plate) and the DePuy Synthes® 90° LCP Pediatric Condylar Plate (90° LCP-PCP) at the University Children’s Hospital Zurich (2020–2024). Consolidation rates were assessed using "Regenerating Bone Defects Using New Biomedical Engineering" (REBORNE), "Radiographic Union Score for Tibial Fractures" (RUST) and modified RUST (mRUST) scores at 6 weeks and 3 months postoperatively and compared using using Wilcoxon signed-rank test. For the comparison between both intervention groups, the unpaired t-test was used for normally distributed data and the Mann–Whitney U test for non-normally distributed and ordinal data. For all tests, values of p < 0.05 were considered statistically significant. Geometric planes of osteotomy were analysed, and a stepwise correction technique was described. A total of 111 osteotomies with complete radiographic follow-up were analysed (77 Blade Plate [69.4
The iliac wing is a frequently used fixation site in the surgical management of pelvic and acetabular fractures. Achieving safe implant placement in this region necessitates a comprehensive understanding of local morphology. However, the morphometric characteristics and surgical safety margins of the thin cortical translucent area (PLA) located in the central iliac wing have not been sufficiently defined. This may pose a significant challenge in evaluating the risk of cortical perforation, particularly during implant placement. This study aimed to evaluate the morphometric characteristics of the PLA and its relationship to fixation corridors. Fifty-one unpaired dry hip bones were examined. The thin cortical translucent region was identified using photoluminescence. Photograph-based measurements were conducted utilising ImageJ software on standardised photographs. Dimensions, area, distances to reference landmarks and relationships with the iliac pillar and supraacetabular corridors were assessed. The safe angular deviation range for anterior inferior iliac spine (AIIS)-origin screw fixation was calculated. Cortical thickness was measured using a digital thickness gauge. The vertical and horizontal diameters and area of the PLA were 56.24 ± 16.56 mm, 59.92 ± 24.83 mm and 28.10 ± 16.47 cm2, respectively. Mean distances to the anterior superior iliac spine, posterior superior iliac spine, iliac crest and acetabular roof were 62.12 ± 19.84 mm, 71.03 ± 12.17 mm, 19.88 ± 11.61 mm and 56.02 ± 9.09 mm, respectively. The safe angular deviation for AIIS-origin screw fixation was 16.94° ± 4.43°. The central cortical thickness was 2.07 ± 1.60 mm (range 0.3–5.9). The PLA is a clinically important region characterised by marked central cortical thinning and individual variability. Individualised morphometric assessment and preoperative imaging may help define safer zones for fixation planning and donor-site procedures. Level V.
Distal tibial fractures are challenging to manage owing to limited soft-tissue coverage and compromised blood supply. Minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) are among the widely used surgical options, but the optimal approach remains unclear. MIPO preserves periosteal blood flow with smaller incisions, while ORIF offers direct visualisation but increases soft-tissue damage. With growing comparative evidence, an updated evaluation of these techniques is necessary. To compare the efficacy and safety of MIPO versus ORIF in adult patients with distal tibial fractures. Following PRISMA guidelines and the Cochrane Handbook, we searched in PubMed, Embase, Cochrane, Scopus, and Web of Science till November 2025. Randomised trials and cohort studies comparing MIPO and ORIF were included. Data extraction was performed independently by two reviewers. Risk of bias was assessed using RoB 2 for RCTs and the Newcastle–Ottawa Scale for observational studies. Random-effects models were used to estimate pooled mean differences and odds ratios, and heterogeneity was assessed using I2. Sensitivity and subgroup analyses were conducted by study design. Nine studies involving 530 patients met our inclusion criteria. No significant differences were found between MIPO and ORIF in AOFAS scores, union time, operative duration, hospital stay, return-to-work time, or major complications. MIPO showed trends toward shorter union time, reduced blood loss, and lower infection rates. Infection analysis showed a nonsignificant odds ratio (OR 0.57; 95
To evaluate the efficacy and safety of aspirin, low-molecular-weight heparin (LMWH), and rivaroxaban for deep vein thrombosis (DVT) prophylaxis after total hip arthroplasty (THA) or bipolar hemiarthroplasty (BHA) for femoral neck fracture, with subgroup analysis stratified by surgical type. This single-center randomized controlled trial (RCT) was conducted between June 2024 and June 2025. A total of 217 consecutive patients with femoral neck fracture undergoing hip arthroplasty were initially screened, and 161 eligible patients were finally enrolled and randomly assigned to the aspirin group, LMWH group, or rivaroxaban group at a 1:1:1 ratio. All patients received standardized intermittent pneumatic compression (IPC) and graduated compression stockings for mechanical DVT prophylaxis, as well as a unified postoperative rehabilitation protocol. The primary outcome was the incidence of lower extremity DVT within 12 weeks postoperatively, confirmed by color Doppler ultrasound. The secondary outcome was the incidence of bleeding-related complications graded by the International Society on Thrombosis and Hemostasis (ISTH) criteria. All patients were followed up at 6, 8, and 12 weeks postoperatively, with routine bilateral lower extremity ultrasound performed at 12 weeks regardless of symptoms. Subgroup analysis was performed on the basis of surgical type (THA versus BHA). Among the 50 patients in the aspirin group, 5 (10.00
Abstract Background Patients who underwent primary total hip arthroplasty (THA) after lumbar spine fusion (LSF) had a higher incidence of complications compared with those who had not previously undergone LSF. This study aimed to determine whether the timing of THA before or after LSF impacts the incidence of THA complications. Methods Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Web of science, Embase, and Cochrane Library from their inception until 1 October 2025. Data from all eligible published studies meeting the inclusion criteria were extracted and subsequently analyzed using a random-effects model to calculate the rates of all-cause revision, dislocation, periprosthetic joint infections, and aseptic loosening. Results Our analysis included 10 studies involving 27,605 patients who underwent THA followed by LSF and 32,002 patients who received LSF prior to THA. There are no significant differences in the rates of dislocation (odds ratio [OR] 1.19, 95% confidence interval (CI) 0.73–1.86, p = 0.45), periprosthetic joint infections (OR 0.91, 95% CI 0.52–1.62, p = 0.76), and aseptic loosening (OR 0.89, 95% CI 0.74–1.08, p = 0.23) between the two surgical sequences, while for all-cause revision, the OR was (OR 1.01, 95% CI 0.70–1.47, p = 0.94), which reached statistical significance. Conclusions Compared with the patients undergoing THA after LSF, no significant difference for complication rates was observed in patients with LSF after THA.
The anterior cruciate ligament (ACL) is a key structure that restricts excessive anterior translation of the tibia and maintains rotational stability. This study aims to dynamically and quantitatively assess the direct effects of ACL resection and total knee arthroplasty (TKA) on lower limb alignment and tibiofemoral joint rotation under passive, unloaded conditions and in the pathological state of osteoarthritis. This retrospective study included 110 patients with varus knee osteoarthritis who underwent Mako for robotic-assisted TKA. Dynamic intraoperative measurements of the lower limb mechanical axis (flexion angle at maximum extension; varus angle) and tibiofemoral rotation at multiple flexion angles (min to max flexion) were recorded at three intervals: pre-ACL resection, post-ACL resection and post-TKA. The variation in rotation amplitude was calculated for successive flexion intervals. Post-ACL resection, a significant decrease in the flexion angle at the maximum extension and varus angle (both p < 0.001) was observed, which was accompanied by increased tibial internal rotation at flexion angles of 60° and above (p < 0.05). Varus alignment was successfully corrected following TKA (p < 0.001). However, tibiofemoral rotational kinematics were significantly modified: the amplitude of internal rotation decreased in the initial flexion arc (min to 30°) but increased in flexion intervals beyond 30° (all p < 0.01). Under passive, unloaded osteoarthritic conditions, ACL resection immediately alters lower limb alignment and increases tibial internal rotation. Although TKA restores coronal alignment, it does not fully restore passive rotational kinematics; whether this affects active weight‑bearing function remains unknown. Accordingly, we hypothesize that rotational stability is as critical as limb alignment in TKA, pending validation with patient-reported outcome measures, functional scores and postoperative follow-up.
Anterior shoulder instability is the most common type of shoulder instability. For cases with subcritical glenoid bone loss, both Bankart repair with remplissage (BR) and the Latarjet procedure are viable surgical options. The aim of this study was to compare the postoperative outcomes in patients undergoing BR and Latarjet procedure. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The methodological index for nonrandomized studies (MINORS) was used to characterize the methodological quality. A literature search was conducted using PubMed, the Cochrane Library, Embase, Web of Science, and Scopus. The analyzed outcomes included postoperative Rowe score, visual analog scale (VAS) score, the Single Assessment Numeric Evaluation (SANE) score, range of motion (ROM), return-to-sport (RTS) rate, RTS time, recurrence rate, revision rate, and complications. Subgroup analysis was performed on the basis of follow-up duration. Overall, 12 studies involving 1186 patients were included. The meta-analysis showed that BR was associated with a significantly lower complication rate than the Latarjet procedure. No significant differences were observed in functional outcomes, ROM, recurrence, revision, RTS, or RTS time. Subgroup analysis showed a significant interaction between follow-up duration and outcomes, particularly for VAS and Rowe scores, with a trend toward better short-term results for BR and better longer-term results for Latarjet. BR and the Latarjet procedure provide comparable clinical outcomes for anterior shoulder instability, with BR demonstrating a significantly lower complication rate. Follow-up duration may influence VAS and Rowe outcomes, suggesting a potential temporal shift in treatment effects. Level of evidence: Level III. Trial registration: CRD42024582343.
