Lateral patellar dislocation (LPD) is a musculoskeletal condition characterized by a complex etiology. Despite significant advancements in management strategies, it continues to pose considerable challenges. Critical anatomic risk factors previously identified include trochlear dysplasia (TD), patella alta, and elevated tibial tubercle–trochlear groove (TT-TG) distance, with TD being the most significant. A thorough risk assessment using predictive models is primarily recommended to assist in patient counseling and to identify high-risk cases, for whom early surgical intervention may be considered. Controversies persist regarding the indications for combined surgical procedures, including tibial tubercle osteotomy (TTO), derotational distal femoral osteotomy (DDFO), and lateral retinacular release (LRR) with medial patellofemoral reconstruction (MPFLR). Moreover, emerging evidence suggests that a deeper understanding of the interplay between anatomic factors may optimize surgical prioritization and improve clinical outcomes. The combined surgical approach should be reserved for meticulously selected cases with substantial anatomic risk factors, while isolated MPFLR may prove adequate for cases with milder grade risk factors. To enhance individualized treatment strategies and improve outcomes for patients with LPD, deeper insights into the interaction of anatomical factors, supported by higher-quality clinical research and advancements in biomechanical modeling, are essential.

Objective: This systematic review and network meta-analysis was performed to explore the optimal dose, efficacy, and safety of tranexamic acid (TXA) treatments versus placebo for high tibial osteotomy (HTO) patients.

Methods: PubMed, Embase, Cochrane Library, Wanfang database, and Chinese National Knowledge Infrastructure (CNKI) databases were searched for the randomized controlled trials (RCTs) meeting prespecified inclusion criteria up to March 2024. Interventions included TXA and placebo treatments. The outcomes included total blood loss, drainage, hemoglobin drop, the occurrence of deep venous thrombosis (DVT) and hematoma. Traditional meta-analysis and network meta-analysis were performed by Stata and R software, respectively.

Results: Traditional meta-analysis revealed that TXA was associated with a decrease in the total blood loss, drainage volume, and hemoglobin drop (p < 0.05). There was no significant difference between TXA and placebo in terms of the occurrence of DVT and hematoma (p > 0.05). Compared with placebo, intravenous (iv) 10 mg/kg, iv 10 mg/kg (3 doses), iv 2 g, iv 2 g (2 doses), iv 2 g + topical (top) 3 g, iv 50 mg/kg, and top 10 mg/kg decreased the total blood loss with statistical significance (p < 0.05). Compared with placebo, iv 10 mg/kg (WMD = −379.91, 95% CI: −378.92, −81.22) decreased the drainage volume with statistical significance. Compared with placebo, iv 10 mg/kg (3 doses), iv 1 g, iv 1 g + top 2 g, iv 2 g + top 1 g, and iv 50 mg/kg decreased the hemoglobin drop with statistical significance. No statistically significant difference was found when the two interventions were compared against each other for the occurrence of DVT and hematoma (p > 0.05). The SUCRA shows that iv 10 mg/kg ranked first for reducing total blood loss (SUCRA, 90.7%) and drainage volume (SUCRA, 94.3%). The SUCRA shows that iv 1 g + top 2 g ranked first (SUCRA, 93.7%) for reducing hemoglobin drop.

Conclusion: Administration with TXA was associated with a decrease in blood loss in HTO patients. The optimal dose of TXA for reducing blood loss was iv 10 mg/kg. As for reducing hemoglobin drop, iv 1 g + top 2 g ranked first. Administration of TXA was not associated with an increase in the occurrence of DVT and hematoma. However, most evidence was graded as low/very low confidence due to study limitations, imprecision, and heterogeneity. Therefore, these findings should be interpreted as preliminary signals rather than definitive conclusions. Further high-quality randomized trials are required to validate dose-dependent efficacy and long-term safety outcomes.

This bibliometric analysis investigates the research trends in immunomodulatory therapies for postmenopausal osteoporosis from 2000 to 2024. Utilizing 950 articles retrieved from the Web of Science Core Collection, we employed CiteSpace, VOSviewer, and R-based Bibliometrix to analyze publication dynamics, collaborative networks, and thematic evolution. Key findings include: (1) a steady rise in annual publications, peaking at 82 articles in 2024, with China (265 articles) and the United States (173 articles) as leading contributors. (2) Research hotspots centered on the RANKL/RANK/OPG pathway, T-cell-mediated inflammation (e.g., Th17/IL-17 axis), and emerging topics such as gut microbiota-bone axis and mesenchymal stem cell differentiation. (3) Clinical strategies prioritized denosumab (anti-RANKL) and IL-17 inhibitors, though long-term safety requires validation. (4) Institutional collaboration spanned continents, with Emory University, Harvard University, and Sichuan University as pivotal hubs. Keyword bursts revealed a shift from foundational mechanisms (e.g., TNF-α/IL-6 signaling) to translational topics like gene editing and precision medicine. Limitations include database bias (exclusive reliance on Web of Science) and undifferentiated clinical versus preclinical studies analysis. This study underscores the transformative potential of immunotherapies in osteoporosis management while advocating for multidisciplinary integration, expanded data sources, and rigorous clinical validation to address existing gaps.

Trial Registration: PROSPERO registration number: CRD42024619714

Objective: Patients with developmental dysplasia of the hip (DDH) are usually accompanied by knee valgus, and the previous studies mainly focused on the deformity of the knee in the coronal plane that led to knee valgus. In the transverse plane, the deformity of the femoral condyle had never been considered. This study aimed to analyze the transverse morphology of the femoral condyle in patients with unilateral DDH and explore the correlation between the morphology of the femoral condyle and lower limb alignment.

Methods: Sixty-seven patients (10 male and 57 female) with unilateral DDH in our center between May 2019 and March 2024 were retrospectively analyzed. Then, the lengths of each part of the femoral condyle were collected from CT, and the ratios of anterolateral condyle to anteromedial condyle (ALC/AMC), posterolateral condyle to posteromedial condyle (PLC/PMC), lateral condyle to medial condyle (LC/MC), anterolateral condyle to posterolateral condyle (ALC/PLC) and anteromedial condyle to posteromedial condyle (AMC/PMC) were calculated. Then, the patients were grouped by Crowe classification to further analyze the morphology of the distal femur condyle. The mechanical axis deviation (MAD) of the lower limbs was evaluated. The Pearson correlation coefficient was used to explore the correlation between knee valgus and the morphology of the femur condyle.

Result: Compared with the contralateral side, the ratio of ALC/PLC (p < 0.001) and the ratio of AMC/PMC (p = 0.031) in the ipsilateral side were significantly greater. Grouped by Crowe classification, the greater ratio of ALC/PLC (p < 0.001) in the ipsilateral side could be found in patients with Crowe III and IV DDH. The greater ratio of AMC/PMC (p = 0.003) was only found in patients with Crowe IV DDH. When the four Crowe type sides are compared with each other, the ratio of ALC/PLC in patients with Crowe III and IV DDH is greater than that of patients with Crowe I and II DDH (p = 0.005). The ratio of AMC/PMC in patients with Crowe IV DDH is greater than that of other Crowe type patients(p = 0.003). Besides, as the severity of DDH increases, the MAD increased, which was correlated with the ratio of the ALC/PLC (r = 0.609, p < 0.001) and the ratio of AMC/PMC (r = 0.229, p = 0.031).

Conclusion: Patients with unilateral high-riding DDH could present with an increased ratio of anterolateral condyle and posterolateral condyle on the ipsilateral side, which may be associated with the occurrence of knee valgus.Level III, prognostic study.

Objective: Changes in the coronal, sagittal, and axial alignments during supra-tubercular biplanar medial opening wedge high tibial osteotomy (STB-MOWHTO) may have different influences on tibial tubercle–trochlear groove (TT–TG) distance, but few pieces of literature have addressed this specific concern. We aimed to analyze the impacts of changes in alignments in different planes during STB-MOWHTO on the TT–TG distance.

Methods: Patients who underwent STB-MOWHTO for varus knee deformity at our hospital were reviewed retrospectively from January 2020 to December 2022. Radiographic parameters, including opening width (OW), distal tibial rotation (DTR), posterior tibial slope (PTS), and TT–TG distance, were assessed before operation and directly postoperatively. Multivariate mixed linear regression analyses were employed to investigate the relationships between OW, the changes in DTR, PTS, and TT–TG distance. Restricted cubic spline curve fitting and threshold effects were used to assess potential non-linear relationships between the independent variables and changes in TT–TG distance. Stratification analysis was conducted to assess the stability of the results.

Results: One hundred and two knee joints from 66 patients were included. TT–TG distance change was positively correlated with OW (β = 0.551, 95% CI: 0.340, 0.762, p < 0.001) and DTR change (β = 0.284, 95% CI: 0.196, 0.371, p < 0.001). Restricted cubic spline curve fitting and threshold effect analyses did not identify any non-linear relationships or inflection points between OW, DTR change, and TT–TG distance change. Further, stratification analysis of DTR in various directions confirmed the stability of the linear relationship between DTR change and TT–TG distance change.

Conclusions: The TT–TG distance change exhibited a positively correlated linear relationship with OW and DTR change during STB-MOWHTO. For every 1 mm increase in OW, TT–TG distance increased by an average of 0.551 mm. For every 1° increase in DTR, TT–TG distance increased by an average of 0.284 mm.

Level of Evidence: Level III.

Objective: Atlantoaxial osteoarthritis (AAOA) cause occipitocervical and retroauricular pain and cervical rotation disorder. Few studies have focused on the relationship between cervical spine structure and the prevalence of AAOA in China. This study aimed to investigate whether the inter-atlanto-occipital ligament ossification, uncovertebral joint degeneration and fat infiltration (FI) in the obliquus capitis inferior (OCI) muscles are associated with atlantoaxial arthritis, and to explore other potential risk factors in a clinical cohort from Eastern China.

Methods: We analyzed CT images of the upper cervical spine from 1021 adult trauma patients scanned at our hospital between January 1, 2014, and July 1, 2024. Atlantoaxial osteoarthritis and uncovertebral joint degeneration were categorized as none-to-mild (no osteoarthritis) or moderate-to-severe (osteoarthritis present). Ossification of the inter-atlanto-occipital ligament was graded 0–3 based on its extent. Risk factors for atlantoaxial osteoarthritis were identified using univariate and multivariable logistic regression analyses. Among these patients, 381 underwent cervical MRI, and we assessed fat infiltration (FI) in the inferior oblique muscles, classifying it into quartiles: mild (8.51%–18.49%), moderate (18.67%–31.56%), and severe (31.88%–46.22%). Multivariate regression analysis was then performed to explore the relationship between FI severity and the incidence of AAOA.

Results: The study group consisted of 59.4% men, with a mean age of 50.18 ± 17.23 years, and an AAOA prevalence of 11.6%. In the primary multivariable logistic regression analysis, the following factors were independently associated with AAOA: age ≥ 50 years (OR 30.48, p < 0.001), inter-atlanto-occipital ligament ossification (OR 1.59, p = 0.033), female sex (OR 2.54, p < 0.001), and uncovertebral joint degeneration in the lower cervical spine (OR 2.38, p < 0.001). In a separate multivariate logistic regression analysis that specifically included the degree of fatty infiltration in the inferior oblique muscles, it was found that greater fatty infiltration was also significantly associated with an increased risk of AAOA (OR 3.52, p < 0.001).

Conclusions: Age over 50 years, inter-atlanto-occipital ligament ossification, female sex, and uncovertebral joint degeneration are significant factors associated with atlantoaxial osteoarthritis. Severe fatty infiltration of the inferior oblique muscles may also be a potential risk factor. Delayed diagnosis and treatment may be prevented by prioritizing these risk factors.

Objective: Postoperative nausea and vomiting (PONV) and abnormal inflammatory markers frequently complicate recovery following total knee arthroplasty (TKA), posing diagnostic challenges in distinguishing between transient inflammatory responses and early infections. This study aimed to evaluate the specific effects of dexamethasone (DXM) on PONV incidence and inflammatory markers after TKA.

Methods: This was a retrospective cohort study including 1853 patients who underwent unilateral TKA from January 2020 to August 2021. Patients were divided into a dexamethasone group (n = 756) and a control group (n = 1097) based on postoperative DXM use. All other perioperative management was consistent between groups. Data collected included PONV incidence, white blood cell count (WBC), C-reactive protein (CRP), and postoperative clinical outcomes. Statistical analysis included the χ² test, t test, and multivariate logistic regression to control for confounding factors.

Results: The DXM group showed significantly lower incidences of PONV and lower postoperative CRP levels. WBC counts and neutrophil percentages were transiently elevated postoperatively in the DXM group without corresponding increases in postoperative complications.

Conclusion: DXM administration after TKA reduces PONV and inflammatory markers but leads to transient leukocytosis, which is not associated with an increased incidence of complications.

Objective: Durable and biologically integrated fixation is critical for long-term implant survival in patients with primary bone tumors. However, limited evidence exists regarding the long-term outcomes of uncemented stem designs in this population. Specifically, we investigated: (1) the long-term patient and implant survivorship rates; (2) the influence of factors such as resection length and patient age on implant survival; and (3) the incidence and types of complications, particularly those requiring implant removal or revision.

Methods: We retrospectively reviewed 76 patients (49 males, 27 females; mean age 41 years, range 14–78 years) who underwent proximal femoral replacement with a modular uncemented endoprosthesis between 2015 and 2022. The mean follow-up was 63.4 months (median: 60.5 months; range: 12–104 months). Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score, while complications were classified based on the Henderson et al. system. Survivorship analyses were conducted using Kaplan–Meier methods.

Results: The 5-year patient survival rate was 88.0%, and the 5-year implant survival rate was 90.4%. The mean MSTS score at final follow-up was 25.6 (range 16–30), with 87.7% of patients achieving good to excellent functional outcomes. Younger patients (< 30 years) exhibited poorer implant survival, while resection length did not significantly impact outcomes. Complications occurred in 18.4% of cases, categorized into type 1 (soft tissue-related, n = 3), type 2 (aseptic loosening, n = 2), type 3 (structural failure, n = 0), type 4 (infection, n = 3), type 5 (tumor recurrence, n = 3), and three cases of acetabular failure.

Conclusions: Modular uncemented endoprostheses for proximal femoral replacement demonstrated promising survivorship and functional outcomes in patients with primary bone tumors. The low rate of aseptic loosening highlights the benefits of uncemented stem designs. However, younger age remains a risk factor for reduced implant longevity.

Objective: The treatment of talocalcaneal coalition (TCC) with pes planus deformity in adolescent patients still presents challenges. With the pes planus deformity untreated, the final clinical outcome would be compromised. Therefore, simultaneous correction of pes planus deformity seems to be of great importance. This study aimed to retrospectively evaluate the clinical efficacy of coalition resection combined with extra-osseous talotarsal stabilization (EOTTS) treatment for adolescent TCC with pes planus deformity.

Methods: Data was reviewed for patients of TCC and pes planus deformity treated by coalition resection and EOTTS from January 2018 to January 2024. Meary's angle and talar-1st metatarsal angle (T1MA) were measured to assess the alignment improvement (paired sample t-test). Visual analog scale (VAS) for pain (Wilcoxon signed rank test) and American Orthopedic Foot & Ankle Society ankle-hindfoot score (AOFAS-AHS) (paired sample t-test) were evaluated for the overall clinical outcomes. Time to return to sports activity and complications were also recorded.

Results: No early wound or soft tissue complications occurred. At 1-year follow-up, Meary's angle and T1MA improved from 13.4° ± 5.2° to 5.1° ± 3.4°, and from 14.7° ± 3.7° to 6.4° ± 2.5°, respectively. The median VAS score decreased from 5 to 0, while the AOFAS-AHS increased from 51.1 ± 8.9 to 90.1 ± 9.3 (all p < 0.05). Fifteen patients returned to sports at a median of 3 months (range: 2–4 months). One patient experienced sinus tarsi pain, which was resolved after implant removal at 14th month postoperatively.

Conclusion: Simultaneous coalition resection and EOTTS for adolescent TCC with pes planus deformity achieves satisfactory clinical outcomes with minimal complications.

Background: Calcified lumbar disc herniation (CLDH) is one specific type of lumbar disc herniation (LDH). Currently, there are no uniform classification standards for different calcification degrees of herniated lumbar disc tissue. Percutaneous endoscopic interlaminar discectomy (PEID) has been proved to exhibit great efficacy in treating LDH, but whether it can achieve satisfactory results in treating CLDH with different calcification remains unclear.

Methods: A total of 271 patients who suffered from single CLDH (97 patients) or NCLDH (non-calcified lumbar disc herniation) who received PEID surgery between January 2016 and December 2018 in our hospital participated in this retrospective study. Moreover, CLDH was divided into four grades based on preoperative sagittal CT images, including 34 Grade I, 22 Grade II, 19 Grade III, and 22 Grade IV. Operative time was evaluated between the two groups. In addition, VAS (leg pain), ODI, and MacNab scale score were applied to assess the efficacy of PEID in treating CLDH with different calcification degrees by Student's t tests or χ² test.

Results: All the patients successfully underwent PEID surgery. According to the analysis, the operative time in the CLDH group was significantly longer than that in NCLDH group. Preoperative and postoperative VAS (leg pain) and ODI scores have no significant differences between the CLDH and NCLDH groups. Furthermore, postoperative modified MacNab scale scores and complication rates were almost the same in the two groups. However, there were some differences in terms of VAS (leg pain), ODI, and MacNab scores during LDH patients with different degrees of calcification. CLDH was divided into four grades in our study, and the analysis displayed that VAS (leg pain) and ODI scores after operation in the Grade IV CLDH group were both obviously higher than those in the control group. Moreover, the modified MacNab scale showed that excellent or good rates in the Grade IV CLDH group (73%) were lowest, and they were significantly lower than those in the control group (91%). The other statistical indexes such as recurrence and complication rates showed no significant difference in CLDH with different degrees of calcification.

Conclusion: CLDH was innovatively divided into four grades in our study. PEID is an effective and safe surgical method for treating CLDH; it can achieve a satisfactory outcome. However, it should be considered carefully in the treatment of lumbar disc herniation with severe calcification (Grade IV).

Background: High dislocation due to developmental dysplasia of the hip (DDH), classified as Crowe type III or IV, presents significant challenges in total hip arthroplasty (THA), particularly in preventing nerve complications while restoring leg length.

Aim: This study aimed to evaluate the clinical and radiographic outcomes of primary THA using an S-ROM-A modular stem with oblique subtrochanteric shortening osteotomy in patients with high hip dislocation; to identify the advantages, limitations, and possible countermeasures of this surgical approach.

Patients and Methods: Subjects were 45 hips (37 patients) with high hip dislocation (Crowe III/IV) treated by primary THA using an S-ROM-A stem, with femoral shortening osteotomy performed at our institution. Outcomes 3 years after surgery were examined in 100% of the subjects. Postoperative complications and functional and radiographic outcomes were investigated.

Results: The mean age at surgery was 65 years and the mean duration of postoperative follow-up was 10.7 ± 3.4 years. There were no cases of postoperative infection, symptomatic pulmonary embolism, or neurological complications in the legs. Early postoperative dislocation occurred in two hips (4%, resolved conservatively) and osteotomy site nonunion in one hip (2%). Repeat surgery was required in only this case of nonunion (2%). The hip function score was significantly improved postoperatively. Leg lengthening after surgery was 0–56 mm (mean, 28 mm). Examination of radiographs revealed that it took 12 weeks for bone union at the osteotomy site in all hips except for the one hip with nonunion. No stem subsidence was found postoperatively, and “fixation by bone ingrowth” was achieved at the final follow-up examination in all hips (100%), including the one that required repeat surgery.

Conclusion: THA using an S-ROM-A modular stem with oblique subtrochanteric shortening osteotomy provided favorable mid-term outcomes in patients with Crowe III/IV DDH. No neurological complications occurred, and functional and radiographic improvements were substantial. Our method, which emphasizes intraoperative sciatic nerve palpation for individualized leg lengthening, may serve as a practical and safe alternative to more complex monitoring systems. Further research incorporating objective intraoperative monitoring may help standardize this approach.

Objective: Given the limitations of conventional anterior and lateral approaches, such as variable success rates and risks of neurovascular injury, there is a critical need to evaluate alternative techniques that enhance procedural safety and efficiency. This study aimed to investigate the safety and precision of the anterolateral approach for hip joint puncture and compare its clinical efficacy with those of the anterior and lateral approaches.

Methods: A single-center, prospective, randomized Williams crossover trial was conducted from March 2023 to June 2023 involving 30 patients with hip pain. Each patient underwent three hip joint punctures within 3 weeks, all conducted using anatomical landmark-guided blind puncture. The punctures were administered in different sequences of anterior, anterolateral, and lateral approaches, with one-week intervals between punctures. Thirty patients were randomly assigned to six groups (n = 5), following different sequences of the three approaches. The primary outcomes were the success rate and accuracy, and the secondary outcomes were post-puncture pain assessed using the Visual Analogue Scale (VAS), procedure time, puncture depth, and complications.

Results: The anterolateral approach achieved a higher success rate (96.7%) compared to the anterior (86.7%) and lateral (83.3%) approaches; although statistical significance was not reached (p = 0.328). Besides, it significantly shortened procedure duration (72.87 s, SD 9.66) compared to anterior (87.20 s, SD 20.57) and lateral (92.80 s, SD 39.02) approaches (p = 0.006). The puncture path length was shorter with the anterolateral approach (57.77 mm, SD 1.295) than with the lateral approach (63.33 mm, SD 1.295) (p = 0.004). The anterolateral approach achieved lower VAS pain scores (1.77, SD 0.94) compared to the lateral approach (2.90, SD 2.17). During the anterior approach injection, one patient experienced numbness in the lateral thigh of the surgical side.

Conclusion: This preliminary randomized crossover trial demonstrates that the anterolateral approach offers significant advantages in procedural efficiency (reduced time, shorter path length) and suggests a trend toward higher success rates compared to standard anterior and lateral approaches for hip joint puncture. These findings, particularly the improvements in efficiency and patient comfort (lower VAS), support the anterolateral approach as an effective technique.

Level of Evidence: I, Randomized controlled trial.

Trial Registration: chictr.org.cn: ChiCTR2300074174

Objective: Severe spinal deformities, including scoliosis and kyphosis, present significant challenges in corrective surgery due to the elevated risk of neurological complications. The identification of preoperative risk factors is of paramount importance for the optimization of outcomes and the prevention of complications.

Methods: This retrospective cohort study analyzed 130 patients with severe spinal deformities who underwent surgical treatments from January 2002 to May 2022. A comprehensive collection and analysis of preoperative clinical, imaging, and surgical data were conducted with the objective of identifying risk factors for neurological complications. Univariate and multivariate logistic regression analyses were conducted to ascertain the independent predictors.

Results: A total of 130 patients were included in the study, with a female ratio of 50% and a mean age of 21.4 ± 15.3 years, and 18 (13.8%) of them experienced postoperative neurological complications. Significant factors included preoperative spinal cord anomalies (38.9% in the complication group vs. 8.9% in the non-complication group, p = 0.001) and a higher kyphosis angle (112.4° in the complication group vs. 98.2° in the non-complication group, p = 0.018). The incidence of intraoperative neuromonitoring alarms was significantly higher in the complication group (38.9% vs. 15.9%, p = 0.022). No significant differences were observed in operative time (p = 0.095) or blood loss (p = 0.179). A higher angle of kyphosis (OR = 1.027, 95% CI: 1.001–1.055, p = 0.045) and the occurrence of spinal cord anomalies (OR = 6.715, 95% CI: 1.694–26.615, p = 0.007) were independent predictors of surgical neurological complications.

Conclusions: Preoperative spinal cord anomalies and a higher kyphosis angle are independent risk factors for postoperative neurological complications. A comprehensive preoperative evaluation is essential for optimizing surgical strategies in these high-risk patients.

Objective: There is a lack of large-scale anatomical studies on children's C5 vertebrae, and experience with posterior cervical spine fixation surgery in children is limited, posing challenging clinical issues. This study aims to investigate the size, morphology, and developmental growth of the C5 pedicle and lateral mass in children under 14 years of age, and to assess the feasibility of screw placement.

Methods: We collected CT image data of children aged 1–14 years who underwent cervical spine CT scans at our hospital from June 2018 to June 2020, measured the imaging anatomy of C5 vertebral arches and lateral masses. The t-test was used for difference testing and the least squares method was used for fit analysis.

Results: The C5 vertebral arches and lateral masses in children increase in size with age, with varying growth rates, initially rapid, then slow in the middle, and rapid again later. In children aged 2–3 years, the C5 pedicle width is 3.56 ± 0.34 mm, and the lateral mass height is 3.84 ± 0.37 mm, allowing for the use of a 3.5 mm diameter pedicle and lateral mass screw in children over 3 years old. Among children aged 1–14 years, the average values of angles A, C, and E show relatively small fluctuations, indicating stable anatomical structures, while angle D significantly increases with age. Fitting analysis results reveal that the various parameters are mainly correlated with power curves, including both quadratic and cubic curves.

Conclusion: In children over 3 years old, both the C5 pedicle and lateral mass reach a diameter of over 3.5 mm, allowing for the placement of a 3.5 mm screw. Preoperative thin-section CT scans and careful measurement of various anatomical parameters are essential. This study provides specific imaging anatomical parameters for the C5 pedicle and lateral mass in children, serving as a morphological anatomical reference for posterior cervical spine fixation surgery and designing pediatric posterior cervical spine screws.

Background: Tibial plateau fracture is one of the common fractures in the lower limb, mostly caused by high-energy injuries, which may be accompanied by different degrees of compression and displacement of the joint surface, affecting the knee joint alignment, stability, and sports function, and improper treatment may cause various complications, which are a more difficult problem in the clinic. The objective of this study was to investigate the biomechanical mechanisms underlying effective closed reduction in the treatment of tibial plateau fractures, particularly focusing on the performance of the homeopathic double reverse traction repositor compared to traditional traction table methods.

Methods: We developed a biomechanical model to analyze the equilibrium mechanics during tibial plateau fracture reduction. A quantitative analysis was performed to evaluate the mechanical forces involved in both the traditional traction table method and the double reverse traction repositor.

Results: Our analysis revealed that the use of a traction table generates an additional bending moment at the tibial plateau, resulting in medial over-distraction and lateral compression. This mechanical imbalance can obstruct fracture reduction and irritate surrounding soft tissues. In contrast, the double reverse traction repositor avoids these adverse forces, reducing soft tissue irritation and improving reduction efficiency by utilizing equilibrium mechanics.

Conclusion: The double reverse traction repositor offers a biomechanical advantage in the reduction of tibial plateau fractures by creating a more balanced mechanical environment. This study enhances the understanding of fracture reduction mechanics and supports the repositor's use not only for tibial plateau fractures but also for other fracture types, such as intertrochanteric, extremity long bone, and comminuted fractures.

Objective: Posterior cruciate ligament tibial avulsion fractures (PCLTAF) are characterized by complex injury mechanisms and treatment difficulties, with no standardized diagnostic or therapeutic guidelines currently available. This study aims to establish a classification-based Bundle-Weaving Zonal Fixation system to facilitate the precise treatment of PCLTAF.

Methods: A retrospective analysis was conducted on 100 patients with PCLTAF treated across multiple centers between 2016 and 2022. Based on fracture morphology, fragment characteristics, bone quality, and the extent of posterior ligamentous complex involvement, a novel classification system—Xu-Chen concise classification—was developed using an inductive approach, categorizing PCLTAF into nine subtypes. Guided by this classification, four bundle-weaving fixation techniques were designed, along with the development of a novel fixation system with tendon-weaving holes. One representative case from each subtype (n = 9) underwent open reduction and subtype-guided individualized fixation. Surgical time, intraoperative blood loss, complications, fracture healing, and functional outcomes (Lysholm and Tegner scores) were assessed.

Results: According to the Xu-Chen concise classification, nine patients (six males and three females; mean age, 45 years) underwent open reduction and individualized bundle-weaving fixation. The average surgical duration was 77.2 min (range, 60–95 min), and the average intraoperative blood loss was 23.3 mL (range, 15–40 mL). The mean follow-up period was 17.89 months (range, 12–22 months). The Lysholm knee score improved from 26.78 preoperatively to 97.22 postoperatively, while the Tegner activity score increased from 2.89 to 9.56. No complications such as deep vein thrombosis, joint stiffness, postoperative swelling, hematoma, infection, fixation failure, joint instability, or refracture were observed during follow-up. Only one elderly patient experienced superficial wound necrosis, which healed with conservative wound care.

Conclusion: The Xu-Chen concise classification and its corresponding tendon-bundled intraosseous fixation system offer a structured and standardized treatment pathway for PCLTAF. Preliminary results demonstrate promising outcomes in anatomical reduction, functional recovery, and surgical safety. This strategy shows clinical value in managing complex cases, such as comminuted fractures and osteoporotic bone.

Objective: Intervertebral disc degeneration (IVDD) has been closely associated with ferroptosis in nucleus pulposus cells (NPCs), the underlying regulatory mechanisms and therapeutic strategies remain poorly defined. This study aims to delineate how ginsenoside Rg3 mitigates IVDD progression through ferroptosis suppression, providing a basis for clinical translation.

Method: An erastin-induced nucleus pulposus cell ferroptosis model was established. Suitable Erastin concentrations (0–20 μM) were screened via CCK-8, qRT-PCR, and Western blotting based on viability, extracellular matrix (COL2A1/ACAN/ADAMTS5/MMP3) and ferroptosis markers (GPX4/FTH-1/ACSL4), followed by determination of optimal Rg3 concentrations (0–150 μM) using identical methods. Key targets of Rg3 were predicted through network pharmacology and verified by qRT-PCR and Western blotting. After establishing a rat tail puncture-induced IVDD model, local injection of Rg3 was administered. Therapeutic efficacy was evaluated by MRI assessment of nucleus pulposus status and disc height, alongside histological and immunohistochemical analyses of Rg3's role in delaying disc degeneration.

Result: 5 μM Erastin effectively induced ferroptosis in nucleus pulposus cells, reducing cell viability, suppressing expression of extracellular matrix anabolic proteins (COL2A1, ACAN), while promoting catabolic factors (MMP3, ADAMTS5) and downregulating ferroptosis inhibitors (GPX4, FTH-1). These alterations were significantly reversed by 100 μM Rg3. Integrated network pharmacology and molecular biological validation identified PRKAA2 as the key target mediating Rg3's anti-degenerative effects. In vivo rat experiments demonstrated that Rg3 treatment preserved disc height and attenuated disc degeneration, with histological and immunohistochemical analyses further confirming its therapeutic efficacy and PRKAA2-targeted regulation.

Conclusion: This study elucidates the therapeutic mechanism of Rg3 in delaying IVDD progression via PRKAA2-mediated ferroptosis inhibition, providing substantial experimental evidence for its clinical translation as a potential disease-modifying agent.

Objectives: Hip abductor tendon tears remain an underrecognized diagnosis, initially classified under Greater Trochanteric Pain Syndrome. This often results in ineffective conservative treatment, providing only temporary pain relief. While certain surgical approaches, particularly knotless double-row repair techniques (Hip Bridge) have shown promising clinical outcomes, comprehensive biomechanical data remain insufficient. Therefore, this study aimed to biomechanically compare Hip Bridge (HB) repair with the standard Mason-Allen (MA) technique using a human cadaver model.

Methods: Gluteus minimus and medius were released in 12 fresh-frozen human cadaveric specimens and reattached to their anatomical footprints either with transosseous MA or knotless double-row HB technique. HB consisted of two proximal PEEK (polyetheretherketone) anchors, each preloaded with double-V shaped tapes, crossed, and distally fixated with two additional anchors. Femurs were fixated in a custom-made sample holder while gluteal muscles were clamped using a cryo-jaw. The construct underwent a cyclic loading test between 10 and 125 N for 150 cycles at 2.5 Hz (preload 10 N), followed by a pull-to-failure test. Failure mode and elongation were determined, the latter by a 3D optical measurement system. Statistical analysis was performed using t-test.

Results: HB repair resulted in significantly higher ultimate failure loads (339.1 ± 144.4 N) compared to the MA technique (209.6 ± 62.1 N, p = 0.0381). HB failed exclusively due to tendon failure, whereas MA exhibited different failure modes: tendon failure (1/6), bone cutting (4/6), and muscle rupture (1/6). During cyclic loading, the calculated final plastic elongation was 4.4 ± 0.5 mm for MA and 3.4 ± 1.4 mm for HB (p = 0.0731). During pull-to-failure testing, stiffness of 59.7 ± 12.5 N/mm (MA) and 66.8 ± 18.4 N/mm (HB) was observed (p = 0.247).

Conclusion: The HipBridge technique provides superior biomechanical stability compared to the standard Mason-Allen repair, showing significantly higher ultimate failure load and reduced failure variability. This advantage may be attributed to greater contact restoration of the anatomical footprint, which is particularly beneficial for treating weakened tendons and bones in elderly patients.

Objectives: Acute compartment syndrome (ACS) is a medical emergency that requires timely intervention, and delays in treatment can lead to severe complications such as nerve injury, muscle necrosis, amputation, and even death. Definitive treatment of ACS requires a fasciotomy. Currently, there is no consensus on the best approach for a forearm fasciotomy; compartment release is most commonly done through volar or combined volar and dorsal incisions. A trans-ulnar single incision approach has been demonstrated to be effective in a case report. This study investigates if a trans-ulnar single incision decompresses both deep volar and dorsal forearm compartments to less than 30 mmHg in a cadaveric model of ACS.

Methods: Ten fresh, frozen cadaveric upper extremities were injected with egg whites and compartment pressures were measured to determine successful simulation of ACS. A single trans-ulnar incision was made between the Flexor Carpi Ulnaris (FCU) and Extensor Carpi Ulnaris (ECU), extending from 4 to 5 cm (2″) proximal to the ulnar styloid to 6 to 8 cm (3″) distal to the olecranon. After blunt dissection to release the compartments, pressures were measured to confirm decompression.

Results: ACS was successfully simulated in all upper extremities to above 30 mmHg. The mean volume of saline injected to simulate local anesthetic was 38.0 ± 4.2 mL. The mean operative time was 10.1 min. The mean compartment readings 1-min post-fasciotomy were 7.1 ± 3.0 mmHg for the deep volar compartment and 9.4 ± 5.6 mmHg for the dorsal compartment. All fasciotomies reduced deep volar and dorsal compartment pressures below the clinical threshold of 30 mmHg, with significant differences between pre- and post-fasciotomy pressures.

Conclusions: All 10 fasciotomies successfully reduced deep volar and dorsal compartment pressures to below the clinical threshold of 30 mmHg, demonstrating the success of the trans-ulnar single incision fasciotomy to decompress compartment syndrome in cadaveric forearms.

Objective: Spinal endoscopic surgery is widely acknowledged as an effective and minimally invasive approach for treating lumbar disc herniation. Comprehensive descriptions of the endoscopic decompression technique for lumbar spinal stenosis (LSS) are limited in existing literature. With a focus on long-term follow-up outcomes, this study investigates the safety and efficacy of endoscopic decompression using a unilateral interlaminar approach.

Methods: Between August 1, 2018, and December 1, 2020, a total of 316 consecutive cases underwent endoscopic decompression for LSS following conservative treatment. Based on specific selection criteria, 176 of these cases were retrospectively included in this study. The minimally invasive decompression was performed using a percutaneous uniportal and lateral interlaminar endoscopic approach under local anesthesia. This endoscopic procedure involved comprehensive decompression of the central canal and unilateral recess, addressing the lamina, hypertrophic ligamentum flavum (LF), and medial osteophytes of the facet joint. Clinical outcomes were assessed using the single continuous walking distance (SCWD) without pain, the modified MacNab criteria, the Oswestry Disability Index (ODI), and the visual analogue scale (VAS). Radiographic changes, both preoperative and postoperative, were documented and analyzed. This analysis included evaluating the stability of the lumbar spine through lumbar hyper-flexion and hyper-extension X-rays, as well as determining the lumbar canal cross-sectional area (CCA) using CT scans.

Results: The mean follow-up period was 47.4 ± 7.1 months. The average operative duration was 65.3 ± 12.6 min, and the mean estimated blood loss was 10.4 ± 8.5 mL. The average length of postoperative hospital stay was 2.2 ± 1.3 days. There was a significant improvement in SCWD without pain (p < 0.05). Postoperatively, the ODI and VAS scores for both back and leg pain showed significant reductions (p < 0.05). Based on the modified MacNab criteria, the overall rate of good-to-excellent outcomes was 95.45%. The CCA increased significantly from 52.0 ± 11.0 to 122.5 ± 12.1 mm² (p < 0.05). The stability of the spine did not exhibit significant changes compared to the preoperative state.

Conclusions: The unilateral interlaminar approach for bilateral endoscopic decompression in the treatment of LSS demonstrated both safety and efficacy, as evidenced by clinical and radiographic outcomes.