Gait impairment is a major manifestation of degenerative cervical myelopathy (DCM). Most previous gait studies have focused on mean spatiotemporal parameters, whereas gait variability may provide a more sensitive indicator of gait instability and fall risk. However, the clinical significance of stride length variability in patients with DCM remains unclear. This study aimed to investigate the clinical significance of stride length variability in patients with DCM by examining its associations with objective and patient-reported clinical measures, as well as other gait parameters. Sixty-three consecutive patients with DCM who completed all assessments were included. Stride length variability was quantified using the coefficient of variation (CV) of stride length during treadmill walking using the KinemaTracer three-dimensional gait analysis system. Associations between stride length variability and objective clinical measures, gait parameters, and the domains of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) were evaluated. Receiver operating characteristic analysis was performed to determine the optimal gait speed cutoff for identifying high stride length variability (CV ≥ 4
Neer type II distal clavicle fractures are unstable injuries. Clavicular hook plates (CHP) provide fixation but can cause subacromial complications and require implant removal. We compared extra-articular all-endoscopic anchor fixation (BEA) with CHP. This single-center retrospective non-randomized cohort included 120 patients treated from July 2022 to June 2025 (BEA, 51; CHP, 69). After discussion of both procedures, patients selected treatment; both techniques were performed by the same general orthopedic team. The primary outcome was the 12-month Constant–Murley Score (CMS). Radiographic union by 6 months was the key secondary radiographic outcome; other secondary outcomes included healing status at scheduled visits, perioperative measures, pain, shoulder function, complications, cortical resorption, and secondary procedures. Because radiographs were obtained at scheduled visits, time to union was not estimated. At 12 months, before CHP removal, CMS was higher in the BEA group than in the CHP group (92.4 ± 5.6 vs. 84.8 ± 6.9; mean difference, 7.6 points; 95
Total joint arthroplasty (TJA) reduces pain in patients with end-stage osteoarthritis, but many still experience residual pain after one year. We aimed to identify preoperative prognostic factors for residual pain and describe their relative strength. We systematically searched Embase, MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to 12 December 2023 and screened the 200 top-ranked Google Scholar records. Eligible studies involved patients undergoing primary TJA for osteoarthritis and comprised prospective or retrospective cohort studies, case-control studies, and prognostic analyses of randomised trials developing or updating an internally or externally validated multivariable prognostic model. Associations were converted to a common correlation scale and pooled using random-effects meta-analysis. Prediction intervals, certainty of evidence, and risk of bias were assessed. Fifty-nine studies (335’921 patients) addressed hip, knee, or shoulder arthroplasty; no eligible studies addressed other prespecified joints. Across joints, poorer mental health (mean correlation coefficient − 0.11; 95
Remote thoracic spinal subdural hematoma after lumbar surgery is exceptionally rare and may be overlooked when postoperative neurological deterioration is initially attributed to the operated lumbar level. A 64-year-old woman with Grade 3 hypertension, scoliosis, and a body mass index of 24.66 kg/m² underwent conventional open posterior midline L5–S1 transforaminal lumbar interbody fusion. No dural tear or cerebrospinal-fluid leakage was documented, and estimated blood loss was 100 mL. She received enoxaparin 40 mg subcutaneously on postoperative days 1 and 2. At 00:25 on postoperative day 3, she developed new thoracic back pain, followed at 02:15 by abrupt paraplegia and sensory loss, approximately 59 hours 40 minutes after the lumbar operation ended. Urgent magnetic resonance imaging showed a posterior T7–T9 intradural hematoma with an inverted Mercedes-Benz configuration. At maximal compression, hematoma thickness was 5.81 mm within a same-axis canal diameter of 11.03 mm, corresponding to a 52.7
Supracondylar humerus fractures(SHFs) are common in children, but the biomechanical stability of Kirschner wire (K-wire) fixation at different fracture levels has not been adequately investigated. This study aimed to compare the biomechanical characteristics of crossed K-wire fixation for SHFs with different fracture levels using finite element analysis (FEA) and to identify the optimal pin configuration, thereby providing a biomechanical basis for personalized surgical planning. A total of 27 types of finite element models were constructed, which showed different insertion angles of crossed K-wires based on the low fracture, the middle fracture, and the high fracture of SHFs. The equivalent (von Mises) stress, equivalent elastic strain, and total deformation were analyzed. The FEA results demonstrated distinct biomechanical characteristics across different fracture levels. For low fractures, smaller insertion angles for the crossed K-wires provided more favorable biomechanical performance. For middle fractures, a configuration combining a larger lateral insertion angle with a smaller medial insertion angle appeared to offer superior mechanical stability. For high fractures, crossed fixation using large insertion angles on both sides showed more favorable biomechanical characteristics. The study established a biomechanical relationship between fracture level and the optimal configuration of crossed K-wire fixation in SHFs. The findings can serve as a reference for optimizing the fixation techniques of the SHFs.
