Introduction: Stable 2-part intertrochanteric hip fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthoapedic Trauma Association [AO/OTA] 31A1.2) are commonly treated with dynamic hip screw (DHS) or trochanteric fixation nail advanced (TFNA). Although nails are increasingly favored, superiority in stable patterns remains unproven with DHS remains widely used. This study applied mesh-free simulation to investigate construct mechanics and failure behavior in stable fracture models, with implant migration and construct stability as surrogate measures for cutout risk. Methods: Particle models of AO/OTA 31A1.2 fractures were obtained from cadaveric computed tomography scans with bone mineral density mapping. Using volumetric particle modelling (100-400 μm resolution), either DHS (316L stainless steel lag screw/barrel) or TFNA (Ti6Al4V extra low interstitial nail/blade) was inserted at a tip-apex distance of <25 mm. A standardized axial compression test approximating single-leg stance was simulated at 2 m/s along the Z-axis. Two implant conditions were tested: sliding (allowing screw/blade migration) and non-sliding (rigid). Two fracture reductions were modelled: anatomical (0 mm gap) and proximal gap (5 mm). Outcomes were maximum load, displacement at failure, load-displacement curves, and von Mises stress distribution. Results: With anatomical reduction, DHS and TFNA showed nearly identical curves up to 3–4 mm displacement; DHS resisted higher loads beyond. In non-sliding, DHS reached a maximum load of 4,066 N vs. 3,945 N for TFNA; in sliding, DHS reached 4,156 N vs. 3,790 N for TFNA. With gap, early performance was similar, but DHS reached higher loads (2,161-2,504 N) vs. TFNA (1,643-1,877 N). Displacement at failure was comparable (approximately 5 mm). DHS exhibited a more gradual postpeak decline, whereas TFNA showed a steeper loss of resistance. Conclusion: DHS and TFNA provide comparable initial stability but diverge with increasing displacement and reduction imperfection. Rather than establishing implant superiority, these findings highlight differences in construct mechanics and tolerance to suboptimal reduction. Clinical Relevance: DHS may better tolerate reduction imperfections in stable intertrochanteric fractures, potentially guiding implant selection when anatomical reduction is challenging. Results should be interpreted as mechanistic insights requiring clinical validation. Level of Evidence: No level of evidence. See Instructions for Authors for a complete description of levels of evidence.
Background:Artificial intelligence (AI)-generated text has been detected in nearly 90% of orthopaedic peer-reviewed publications, yet public disclosure of AI use remains extremely low. Whether journal and publisher policies for authors on AI use are present, sufficiently detailed, and internally consistent has not been systematically examined in orthopaedics. We characterized the prevalence, scope, and within-publisher consistency of AI policies across a structured sample of leading orthopaedic and biomedical journals. Methods:We performed a cross-sectional analysis of publicly available author instructions, editorial policies, and publisher guidance for 32 journals (6 core orthopaedic, 19 orthopaedic subspecialty, 7 general biomedical) across 12 biomedical publishers. Forty-one variables were extracted per journal between March and April 2026, including presence of policy for AI use for authors, disclosure requirements, and use of AI for data analysis, generating figures and references, and policies for peer reviewers. A second reviewer independently coded a 12-variable subset for 10 journals (31% calibration) to assess inter-rater reliability (Cohen's kappa = 0.90, 96% agreement). Results:Twenty-nine of 32 journals (91%) had an identifiable AI policy for authors; 3 subspecialty journals had none. All core orthopaedic (6/6) and general biomedical (7/7) journals had policies, versus 16 of 19 subspecialty journals (84%). Among journals with policies, 28 of 29 (97%) required disclosure of AI use by authors and 22 of 29 (76%) prohibited listing AI as an author. Coverage of other domains was less frequent: figures and images (66%), hallucinations or fabrication (62%), AI-generated references (48%), peer review (45%), and data analysis (41%). Conclusions:Domains that can directly impact scientific integrity and clinical practice, such as AI-assisted manipulation of data, statistical outputs, fabricated references, and undisclosed image alterations, are currently not consistently queried in detail at manuscript submission. With advances in software technology, biomedical journals can test and adopt AI-detection tools that are both sensitive and specific to screen all submissions before peer-review to maintain scientific integrity and transparency. Level of Evidence:Level IV, Cross-Sectional Study.
Background: There are limited results about total ankle arthroplasty (TAA) in the setting of severe malalignment. The aim of this study was to compare midterm patient-reported and radiographic outcomes in patients with severe varus or valgus tibiotalar deformity treated with primary transfibular TAA at a minimum of 5-year follow-up. Methods: Retrospective review was performed of all primary transfibular TAA by a single surgeon from October 2012 to January 2020 and grouped based on preoperative coronal talar tilt angle. Severe preoperative deformity included cases with ≥10° of varus (n = 36) or valgus (n = 33), while cases within 5° of neutral coronal alignment (n = 140) served as a control group. PROMs included 12-item Short-Form Health Survey physical and mental component scores, Ankle Osteoarthritis Scale, and Visual Analog Scale. Alignment and periprosthetic cysts (>2 mm) were assessed on postoperative radiographs. Adverse events and reoperations were reported using the Canadian Orthopaedic Foot and Ankle Society Reoperation Coding System. Results: Aside from age (Neutral vs. Valgus, 58.1 vs. 64.2 years; p = 0.01), there were no significant differences in demographics, preoperative, or postoperative PROMs among the 3 groups. The median preoperative talar tilt was −15.1° (interquartile range [IQR], −17.8° to −13.1°) in the Varus and 16.0° (IQR, 12.0° to 19.5°) in the Valgus groups; there were no significant differences in median tibiotalar alignment between the 3 groups postoperatively. In the Neutral group, 1 patient had postoperative varus, and 2 patients had postoperative valgus deformity. In the Varus group, 1 patient had recurrent varus, and 1 patient progressed to valgus. Seven ankles had periprosthetic cysts. Overall reoperation rates were similar (Neutral, 34%; Varus, 33%; Valgus, 36%) with no implant revisions. Conclusion: Transfibular TAA is capable of correcting severe coronal tibiotalar malalignment in the primary treatment of end-stage ankle arthritis. Patients with ≥10° varus or valgus deformity demonstrated postoperative patient-reported and radiographic outcomes similar to those with neutral ankle alignment at midterm follow-up, without an increased risk of reoperations. Level of Evidence: Level III . See Instructions for Authors for a complete description of levels of evidence.
Background: Knee osteoarthritis (OA) causes significant disability with limited effective treatments. Undenatured collagen type II (UC-II), prescription-grade crystalline glucosamine sulfate (pCGS), and diacerein have been proposed as alternatives to conventional analgesics, but their comparative efficacy remains uncertain. We hypothesized that each supplement would demonstrate superior efficacy over placebo in reducing total Western Ontario and McMaster Universities Arthritis Index (WOMAC) score at Week 24 in patients with mild-to-moderate knee OA. Methods: This 4-arm, randomized, double-blind, placebo-controlled trial enrolled 216 Thai adults with symptomatic knee OA (Kellgren-Lawrence grade 2-3). Participants received UC-II (40 mg once daily), pCGS (500 mg 3 times daily), diacerein (50 mg once to twice daily), or placebo for 24 weeks, with follow-up to 36 weeks. The primary outcome was total WOMAC score (22 items; pain, stiffness, and physical function; scored 0-220, higher = worse) at Week 24. Analyses followed intention-to-treat principles using multiple imputation by chained equations (m = 10) and linear mixed-effects models. Results: Of 216 randomized Thai participants, 208 (96.3%) completed follow-up (mean age 61.7 ± 7.1 years; 90.9% female; 73.6% Kellgren-Lawrence grade 2). At Week 24, no supplement demonstrated superiority over placebo. Between-group differences in total WOMAC score were as follows: UC-II −4.7 (95% CI −18.6 to 9.1), pCGS −8.1 (95% CI −21.8 to 5.7), and diacerein −12.3 (95% CI −25.9 to 1.3). All 95% CIs included zero, and all point estimates were at or below, and none clearly exceeded, the minimum clinically important difference threshold. At 36 weeks, results were consistent: UC-II −1.8 (95% CI −15.5 to 12.0), pCGS −4.8 (95% CI −18.4 to 8.7), and diacerein −1.3 (95% CI −14.9 to 12.3). Secondary outcomes including pain scores, joint space width, and functional performance showed no significant between-group differences. Adverse events were mild and comparable across groups; no serious adverse events occurred. Conclusions: Among Thai patients with mild-to-moderate knee OA, UC-II, pCGS, and diacerein did not demonstrate superiority over placebo in reducing pain or improving function at 24 weeks. These findings do not support their routine use as monotherapy for knee OA. Trial Registration: Thailand Clinical Trial Registry (TCTR20210901003). Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
Background: Evidence-based and quality-of-care guidelines for hip fracture have recommended providing timely surgery and postacute rehabilitation. We sought to evaluate the cost-effectiveness of providing early surgery (within 24 hours of emergency department admission) and immediate admission to inpatient rehabilitation postacute discharge, or a combination of both for the management of hip fracture patients in Ontario, Canada. Methods: We used a Markov state transition model to compare early surgery and immediate rehabilitation to surgery beyond 24 hours and no postacute rehabilitation or receiving it beyond 24 hours postacute discharge. Costs and Quality-adjusted life-years (QALYs) were estimated in a 5-year horizon for elderly patients, from the perspective of the (public) insurance payer in Ontario, using linked administrative data sets. Transition probabilities and costs were obtained from regression models fitted using linked administrative data sets. EuroQoL 5-Dimension (EQ-5D) utility values were obtained from an international prospective observational study. We performed base-case and probabilistic sensitivity analysis using 5,000 simulations for willingness-to-pay thresholds from $0-$300,000 Canadian Dollars (CAD). Results: The incremental cost-effectiveness ratio of timely rehabilitation, for both timely surgery and rehabilitation, compared with neither were $124,162 and $83,714 per QALY, respectively. Timely surgery alone was an absolute advantage strategy (Δ Cost = −$2,387, Δ QALY = 0.06). Five-year base-case costs ranged from $130,747 to $156,848 and QALYs from 2.13 to 2.37. Timely surgery alone had the highest probability of being cost-effective up to a willingness-to-pay threshold of $128,000 per QALY, whereas combined surgery and rehabilitation was favored above $130,000 per QALY. Results were qualitatively similar for common diagnoses and procedure modalities. Conclusion: Our population data and modelling results indicate that timely surgery can improve patients’ quality of life while reducing costs. Adding inpatient rehabilitation yields greater QALYs but at higher cost. Level of Evidence: Economic Level IV . See Instructions for Authors for a complete description of levels of evidence.
