Artificial Intelligence (AI) is a dynamic area of computer science that is constantly expanding its practical benefits in various fields. The aim of this study was to analyze AI-guided radiological assessment of femoral neck fractures by performing a systematic review and multilevel meta-analysis of primary studies. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on May 21, 2024 [CRD42024541055]. The updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were strictly followed. A systematic literature search of PubMed, Web of Science, Ovid (Med), and Epistemonikos databases was conducted until May 31, 2024. Critical appraisal using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool showed that the overall quality of the included studies was moderate. In addition, publication bias was presented in funnel plots. A frequentist multilevel meta-analysis was performed using a random effects model with inverse variance and restricted maximum likelihood heterogeneity estimator with Hartung-Knapp adjustment. The accuracy between AI-based and human assessment of femoral neck fractures, sensitivity and specificity with 95% confidence intervals (CIs) were calculated. Study heterogeneity was assessed using the Higgins test I² (low heterogeneity <25%, moderate heterogeneity: 25%–75%, and high heterogeneity >75%). Finally, 11 studies with a total of 21,163 radiographs were included for meta-analysis. The results of the study quality assessment using the QUADAS-2 tool are presented in Table 2. The funnel plots indicated a moderate publication bias. The AI showed excellent accuracy in assessment of femoral neck fractures (Accuracy = 0.91, 95% CI 0.83 to 0.96; I² = 99%; p < 0.01). The AI showed good sensitivity in assessment of femoral neck fractures (Sensitivity = 0.87, 95% CI 0.77 to 0.93; I² = 98%; p < 0.01). The AI showed excellent specificity in assessment of femoral neck fractures (Specificity = 0.91, 95% CI 0.77 to 0.97; I² = 97%; p < 0.01). AI-guided radiological assessment of femoral neck fractures showed excellent accuracy and specificity as well as good sensitivity. The use of AI as a faster and more reliable assessment tool and as an aid in radiological routine seems justified.

Objective: Although endoscopic technologies have been increasingly applied in lumbar fusion surgery in recent years, the advantages and disadvantages of endoscopic posterolateral fusion compared with lateral fusion remain unclear. Six different single-level lumbar interbody fusion procedures were compared to determine whether indirect decompression fusion could achieve levels of efficacy and safety comparable to those of minimally invasive direct decompression fusion in the treatment of lumbar degenerative disease (LDD).

Method: A literature search was conducted in the PubMed, Embase, and Cochrane Library databases, and studies on the treatment of LDD published from 2004 to March 2024 were retrieved. The data of preset clinical outcome measures, including operation time, intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, and the Oswestry Disability Index (ODI), were extracted from the studies.

Results: Thirty-five studies with 3467 patients were included in this review. Network meta-analysis revealed no significant differences in improvements in pain and disability or adverse events among the procedures, except for uniportal endoscopic lumbar interbody fusion (UELIF), which resulted in a lower degree of improvement in the ODI than oblique lateral interbody fusion (OLIF). Stand-alone lateral lumbar interbody fusion (SA-LLIF) exhibited the best performance in terms of indicators of early efficacy, such as surgical time and LOS. OLIF and SA-LLIF had higher fusion rates than did UELIF and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). MIS-TLIF resulted in greater EBL than did OLIF, SA-LLIF, and UELIF.

Conclusion: Minimally invasive lumbar interbody fusion achieves good therapeutic results in LDD patients regardless of the use of indirect or direct decompression, whereas SA-LLIF has better early efficacy.

In resource-limited settings, selecting the appropriate treatment for femoral fractures is crucial as it affects both patient recovery and the efficient use of medical resources. This review explores the treatment options for adult and elderly patients with surgical contraindications suffering from femoral fractures, with a particular emphasis on the trade-offs between surgical intervention and traction therapy. Through a systematic literature search of major databases such as PubMed, Web of Science, and the Cochrane Library, we identified 39 studies that met the inclusion criteria, focusing on complications, treatment effectiveness, functional recovery, and cost analysis. We found that although intramedullary nailing may offer better clinical outcomes, traction therapy often becomes the treatment of choice in resource-poor environments due to limited surgical resources. The professional judgment of physicians (OR 10.81; 95% CI 8.28–14.11), patient preferences (OR 1.33; 95% CI 0.80–2.21), and hospital surgical capacity (OR 1.87; 95% CI 0.56–6.28) are key factors influencing treatment choice. For elderly patients, the choice of treatment requires a balance between the risks of surgery and the potential complications of non-surgical treatment (OR 0.78; 95% CI 0.10–5.90). Ultimately, the decision-making process is complex and requires a comprehensive consideration of available resources, cost-effectiveness, patient health status, physician experience, patient preferences, and expected clinical outcomes. In resource-constrained areas, this process is particularly challenging and necessitates a careful consideration of the risks and benefits of both surgical and non-surgical treatment options.

Objectives: Preoperative levels of certain inflammatory markers in the blood can predict acute infection after primary total joint arthroplasty in patients without inflammatory disease, but whether they can do so in patients with rheumatoid arthritis is unclear. The objectives of this study were to determine whether, with appropriate cut-off values, (1) preoperative levels of NLR predicted postoperative acute infection; and (2) preoperative plasma fibrinogen, monocyte-lymphocyte ratio, C-reactive protein or erythrocyte sedimentation rate predicted postoperative acute infection.

Methods: We retrospectively analyzed 964 patients with rheumatoid arthritis who underwent primary total joint arthroplasty at our hospital between January 2010 and November 2020. We compared preoperative levels of inflammatory markers including neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), plasma fibrinogen (FIB) between patients who suffered acute infection or not within 90 days after surgery. The ability of markers to predict infection was assessed in terms of the area under receiver operating characteristic curves (AUC) based on optimal cut-off values determined from the Youden index.

Results: Among the 964 patients, 27 (2.8%) experienced acute infection. Preoperative levels of individual inflammatory markers predicted infection with the following AUCs and cut-off values: NLR, 0.704 (cut-off: 2.528); MLR, 0.608 (0.2317); CRP, 0.516 (4.125 mg/L); ESR, 0.533 (66.5 mm/h); and FIB, 0.552 (3.415 g/L). The neutrophil-lymphocyte ratio showed diagnostic sensitivity of 92.6% and specificity of 43.3%, while the monocyte-lymphocyte ratio showed sensitivity of 77.8% and specificity of 46.3%.

Conclusion: The preoperative NLR shows some ability to predict acute infection after total joint arthroplasty in patients with rheumatoid arthritis. Monitoring this ratio, perhaps in conjunction with other markers not analyzed here, may be useful for optimizing the timing of surgery in order to minimize risk of postoperative infection.

Purpose: Evaluate the efficacy of a novel unilateral dual-plane puncture technique in improving bone cement distribution and reducing vertebral re-collapse following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). By introducing the novel unilateral dual-plane puncture technique, this study aims to improve cement distribution, reduce the incidence of re-collapse, and enhance long-term clinical outcomes for patients suffering from OVCFs.

Methods: This is a randomized trial conducted from April 2021 to December 2022, enrolling 145 patients diagnosed with OVCFs. Patients were allocated into either traditional or unilateral dual-plane puncture groups. Bone cement distribution, vertebral height, and segmental kyphotic angle were measured through postoperative x-ray, while clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Statistical analysis was performed using the Mann–Whitney U test and independent samples t test for continuous variables, and chi-square or Fisher's exact test for categorical variables.

Results: The unilateral dual-plane puncture technique notably augmented bone cement contact with both superior and inferior endplates compared to conventional methods, achieving rates of 64.86% versus 40.85% (p < 0.001). This contributed to a significant reduction in the incidence of vertebral re-collapse within the first year post-operation: 18.92% in the unilateral dual-plane group as opposed to 42.25% in the traditional group (p < 0.001). Furthermore, the unilateral dual-plane group exhibited markedly superior long-term efficacy, evidenced by mean VAS and ODI scores of 1.26 and 28.58, respectively, in comparison to 2.03 and 32.45 in the traditional group.

Conclusions: The unilateral dual-plane puncture technique advances bone cement distribution within the vertebra, thereby reducing the risk of vertebral re-collapse following PVP surgery and improving long-term clinical outcomes for patients with OVCFs.

Objective: The paraspinal muscles are a crucial component of the spine's extrinsic stabilization system. While the impact of paraspinal muscle sarcopenia on patient-reported outcome measures (PROMs) after lumbar surgery is well known, its effects following percutaneous transforaminal endoscopic discectomy (PTED) have not been investigated. To investigate the prognostic value of preoperative paraspinal sarcopenia on long-term PROMs after PTED, and to identify independent predictors of chronic postoperative low back pain.

Methods: In this retrospective cohort study, 145 patients who underwent PTED for lumbar disc herniation (2017–2022) were stratified into sarcopenia (n = 52) and non-sarcopenia (n = 93) groups using sex-specific psoas muscle index (PMI) thresholds (male: < 6.36 cm²/m²; female: < 3.92 cm²/m²). Preoperative MRI/CT was used to quantify paraspinal muscle parameters, including PMI, multifidus muscle index (MMI), erector spinae muscle index (EMI), Goutallier-classified fat infiltration (FI) severity (Grades 0–4), and multifidus muscle density (MMD). Primary outcomes were assessed via the visual analog scale (VAS; 0–10) and Oswestry disability index (ODI; 0%–100%) at preoperative, 1-month, 6-month, and final follow-up (mean 65.6 weeks). Multivariate logistic regression was performed to identify independent predictors of chronic pain (defined as VAS ≥ 4 at final follow-up).

Results: The study cohort comprised 145 patients (69 female, 76 male; mean age: 50.1 ± 7.6 years). The sarcopenia group exhibited significantly lower muscle indices (PMI: 4.55 vs. 7.48 cm²/m², p < 0.001, MMI: 2.61 ± 0.80 vs. 3.66 ± 0.94 cm²/m², p < 0.001, EMI: 9.72 ± 2.46 vs. 12.54 ± 2.27 cm²/m², p < 0.001) and higher FI severity (p < 0.05). At final follow-up, the sarcopenia group reported significantly worse pain (VAS: 3.04 ± 1.25 vs. 2.31 ± 1.50, p = 0.004) and disability (ODI: 28.33 ± 6.61 vs. 21.57 ± 7.28, p < 0.001). Multivariate analysis identified BMI (OR = 1.319), PMI (OR = 0.745), MMI (OR = 0.454), and moderate/severe multifidus FI (OR = 7.036) as independent predictors of chronic pain (all p < 0.05).

Conclusion: Paraspinal sarcopenia, particularly multifidus degeneration, is a modifiable determinant of chronic pain after PTED. Preoperative muscle quality assessment combined with targeted rehabilitation may optimize outcomes.

Objectives: In patients with lumbar spinal stenosis (LSS) undergoing unilateral biportal endoscopic unilateral laminotomy for bilateral decompression (UBE-ULBD), damage to the epidural venous plexus often leads to bleeding, increasing the risk of surgical complications. Surgiflo Hemostatic Matrix (SHM) is a gelatin extracted from porcine skin, used for intraoperative hemostasis. This study aims to evaluate the effectiveness and safety of using SHM during UBE-ULBD surgery.

Methods: From October 2023 to July 2024, a total of 96 patients with LSS underwent UBE-ULBD surgery. These 96 patients were randomly divided into two groups: the SHM group (48 patients, using flowable gelatin) and the non-SHM group (48 patients, not using flowable gelatin). The primary outcomes included intraoperative blood loss, postoperative drainage volume, and the 3-min hemostasis success rate. Secondary outcomes included symptomatic postoperative epidural hematoma (SPEH), surgical time, postoperative hospital stay, hospitalization costs, and complications. We used independent sample t-tests to compare continuous data, and chi-square tests or Fisher's exact tests to analyze categorical data.

Results: The intraoperative blood loss and postoperative drainage volume in the SHM group were significantly less than those in the non-SHM group (p < 0.05), and the 3-min hemostasis success rate in the SHM group was significantly higher than that in the non-SHM group (p < 0.05). There were no statistically significant differences between the two groups regarding SPEH, postoperative hospital stay, hospitalization costs, and complications such as thrombosis formation and allergic reactions. However, the surgical time in the SHM group was significantly shorter than that in the non-SHM group (p < 0.05).

Conclusion: When patients with LSS undergo UBE-ULBD, the use of fluid gelatin can effectively reduce intraoperative and postoperative bleeding without introducing additional complications.

Objective: Clinically, simple glenoid fractures are less prevalent, and surgical treatment of anterior glenoid fractures is often based on the classic anterior approach (delto-pectoral approach), while there are few reports on the efficacy of the trans-axillary approach. The objective of this study is to explore the clinical efficacy of both approaches in the treatment of Ideberg Types I and II scapular glenoid fractures.

Methods: The trans-axillary approach is the surgical method of exposing a glenoid fracture along the anterior edge of the latissimus dorsi muscle through an axillary incision. In terms of the Ideberg classification of scapular glenoid fractures, 36 patients with Ideberg Types I and II scapular glenoid fractures were retrospectively analyzed. There were 22 males and 14 females, and 9 cases of traffic injuries, 6 cases of high fall injuries (> 1 m), 18 cases of fall injuries (≤ 1 m), and 3 cases of strain injuries. Meanwhile, there were 29 cases of Type Ia, 2 cases of Type Ib, and 5 cases of Type II. Based on the surgical approach, the patients were divided into the trans-axillary approach group (21 cases) and the delto-pectoral approach group (15 cases). The following data were collected: general information including age, gender, and body mass index; hospitalization time, operation time, bleeding volume; disability of the arm, shoulder, and hand (Quick DASH [QDASH]); and patient satisfaction. Comparisons between the groups were made using the t test for two independent samples.

Results: Operative time was significantly shorter in the trans-axillary approach group than in the delto-pectoral approach group (t = 6.39, p < 0.05). Constant–Murley score was significantly higher in the trans-axillary approach group than in the delto-pectoral approach group (t = 4.96, p < 0.05). QDASH score was lower in the trans-axillary approach group than in the delto-pectoral approach group (t = 2.66, p < 0.05). Patient satisfaction was higher in the trans-axillary approach group than in the delto-pectoral approach group (t = 4.5, p < 0.05). All fractures healed by the final follow-up.

Conclusion: Trans-axillary approach to the treatment of scapular glenoid fractures is less traumatic and less painful, associated with good recovery of shoulder joint function and high patient satisfaction, and more advantageous compared with the delto-pectoral approach.

Background: The impact of posterior lateral tibial plateau fractures (PLTPFs) on knee joint stability after anterior cruciate ligament (ACL) reconstruction has garnered widespread attention. However, limited literature exists on the co-occurrence of ACL tibial avulsion fractures (ACLAFs) and PLTPFs. The objective of this study is to investigate the prevalence of PLTPFs in adult ACLAF patients and assess the impact of concurrent PLTPFs on postoperative knee function.

Methods: This retrospective study analyzed adults, who underwent arthroscopic surgery for ACLAF at our institution between January 2016 and January 2022. Demographic and preoperative/postoperative imaging data were collected, focusing on meniscus and ligament injuries, Segond fractures, PLTPFs, and tibial plateau slope. Patients were grouped into isolated ACLAF (I-ACLAF) and ACLAF with concurrent PLTPFs (ACLAF-PLTPF). The ACLAF-PLTPF group was further divided into Group A (PLTPFs not exceeding the anterior edge of the lateral meniscus posterior horn) and Group B (PLTPFs exceeding this edge). Clinical outcomes were evaluated using International Knee Documentation Committee and Tegner scores. The study also examined the morphology of PLTPFs and their specific affected areas. Statistical analysis was performed using the Mann–Whitney U tests for continuous variables and Fisher's exact tests for categorical variables.

Results: The study included 62 patients with a mean follow-up of 41 ± 17 months. Among these, 71.0% (44/62) patients with ACLAF also had PLTPFs. The ACLAF-PLTPF group showed a significantly steeper lateral tibial plateau slope than the I-ACLAF group (10.86° ± 5.47° vs. 7.17° ± 3.68°, p = 0.011). Segond fractures were present in 22.7% of the ACLAF-PLTPF group, compared to none in the I-ACLAF group (p = 0.027). IKDC and Tegner scores were lower in the ACLAF-PLTPF group (80.7 ± 5.2 and 4, respectively) than in the I-ACLAF group (87.4 ± 6.4 and 4.5, respectively), with statistical significance (p < 0.001 and p = 0.008, respectively). Older age correlated with a greater extent of concurrent PLTPFs (p = 0.038). Additionally, Patients in Group B exhibited a significantly higher incidence of meniscal injury (22.2% vs. 53.8%, p = 0.036) and poorer postoperative knee joint function compared to those in Group A (IKDC 82.3 ± 2.8 vs. 78.5 ± 5.6, p = 0.013). More extensive PLTPFs were linked to increased fracture collapse and a higher rate of lateral meniscus injuries.

Conclusion: PLTPFs demonstrated a high prevalence in adults with ACLAF. Additionally, the ACLAF-PLTPF cohort frequently showed reduced postoperative knee function. Simultaneous management of severe concomitant PLTPFs may improve long-term outcomes in patients with ACLAF.

Objectives: Different alignment strategies (kinematic alignment [KA] versus mechanical alignment [MA]) during total knee arthroplasty (TKA) significantly influence postoperative patellar tracking. This study aimed to compare radiological parameters of patellar tracking and clinical outcomes between KA-TKA and MA-TKA via the mini-subvastus approach.

Methods: This prospective randomized controlled study included 234 patients who underwent KA-TKA and MA-TKA from January 2022 to October 2023. The preoperative and postoperative patellar tilt, lateral patellar shift, knee society score (KSS), oxford knee score (OKS), and intraoperative patellar lateral retinacular release (LRR) rate were measured. In addition, radiological parameters and clinical outcomes were compared between the LRR and non-LRR groups. Independent samples t test and chi-square test were used to compare the differences between groups.

Results: Two-hundred and thirty-four patients were followed up for 12 months post-TKA. No significant differences were observed between the two groups in terms of the demographics and pre- or post-operative radiological parameters of patellar tracking (p > 0.05). The postoperative KSS and OKS were significantly higher in the KA group than in the MA group (p < 0.05). The LRR rate was 6.7% (8/120) in the KA group and 25.4% (29/114) in the MA group, and the difference was statistically significant (x² = 15.476, p < 0.001). The preoperative patella tilt and lateral patellar shift were greater in the LRR group (p < 0.001) and the postoperative OKS was lower (p < 0.05).

Conclusions: KA-TKA via the mini-subvastus approach can achieve both good patellar tracking and clinical outcomes. Avoiding muscle damage and refraining from excessive soft tissue release are crucial to improving postoperative patient comfort. In our opinion, KA-TKA via the mini-subvastus approach may be a more suitable surgical option.

Objective: Although post-arthroscopy osteonecrosis of the knee is well-documented in the literature, its etiology and prognosis remain unclear. The purpose of this study is to present a group of individuals who experienced avascular necrosis following knee arthroscopy, to examine the factors leading to this condition and assess the outcomes of treatment, as well as to perform a literature review on the subject.

Methods: We retrospectively studied patients between January 2015 and March 2024 who had developed knee osteonecrosis following a standard arthroscopic procedure for treating meniscal tears. All adult patients with isolated meniscus tears and grade 2 or less chondral lesions were included. Patients with evidence of bone edema on MRI performed 4–6 weeks after the onset of preoperative symptoms were not included in the study. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used as an outcome measure. A correlation analysis was performed to explore the degree of association between variables, with significance set at p < 0.05.

Results: Eight patients out of 974 arthroscopies met the inclusion criteria. There was one woman and seven men (mean age 57 [range: 51–71]). The lesions noted at arthroscopy included seven medial meniscus tears that were treated with excision and one lateral meniscal tear that was treated with suture repair and still developed osteonecrosis. None of them were traumatic while all patients had early degenerative changes in the compartment of interest.

Conclusions: Osteonecrosis should be suspected in older patients experiencing worsening symptoms following knee arthroscopy for degenerative meniscus tears and partial meniscectomy. Increased age, a higher BMI, and a delayed diagnosis appear to be associated with more severe disease progression and the need for operative treatment.

Purpose: Understanding the risk factors associated with unscheduled readmission following lateral lumbar interbody fusion (LLIF) is crucial for mitigating the occurrence of these costly events. This study aims to ascertain the incidence and factors of unscheduled hospital readmission subsequent to LLIF.

Methods: A retrospective analysis was conducted on patients who underwent LLIF at our institution from March 2016 to February 2023. Instances of unscheduled hospital readmission after LLIF were meticulously recorded, including baseline demographics, characteristics of spine pathology, surgical interventions, duration between two hospitalizations, and hospitalization costs and duration. Reasons for readmission were categorized based on their etiology. A case–control methodology was employed to compare unscheduled hospital readmission patients against planned readmission patients due to staged surgery. Parametric data were analyzed with a two-tailed T-test, nonparametric data with the Wilcoxon rank-sum test, and categorical data with the χ² test.

Results: A total of 1521 patients who received LLIF at our institution were included in the study. A total of 59 patients (3.88%) were unscheduled readmitted due to adjacent segment disease (ASD), cage subsidence, the original surgical segments remaining narrow, spondylodiscitis, and pain. 51 patients (3.35%) experienced reoperation, predominantly attributable to ASD. Compared to planned readmission patients, unscheduled readmission patients tended to be younger, had a lower likelihood of having scoliosis, and were more likely to have short-segment surgery and higher initial hospitalization costs. Among unscheduled readmission patients, patients receiving short-segment surgery, as well as those who paid less during the initial hospitalization, demonstrated a higher likelihood of a 90-day readmission rate.

Conclusion: Our findings indicated the heightened risks of unscheduled hospital readmission after LLIF. Taking targeted measures against these risk factors is expected to reduce the healthcare burden caused by unplanned readmissions in the future.

Objective: In patients with varus deformity of the knee, the redistribution of the subchondral bone mineral density (BMD) of the tibia leads to sclerotic zones that may cause osteoarthritis. Drilling the sclerotic area of the tibia prior to cementing during total knee arthroplasty is advisable practice. However, the extent of the sclerotic area and the effect of drilling on the tibial component are not well defined. We aimed to quantify the BMD and sclerotic bone distribution of the knee to clarify the effect of drilling on the stability of the prosthesis.

Methods: Our retrospective cohort study enrolled a total of 97 patients from December 2018 to December 2019, categorized into drilled and nondrilled groups, with their computed tomography (CT) knee joint images documented. The proximal tibia image was divided into nine regions, the BMD of each region calculated, and CT values compared between the affected and normal sides. We established finite element models to analyze the drilling and stress distribution. The differences in CT values were assessed using the paired t test and Wilcoxon signed-rank test.

Results: The mean thickness of sclerotic bone was 7.7 ± 1.4 mm, and the surface area was 441.9 ± 89.4 mm². The CT values of the affected anteromedial, anterolateral, mediomedial, mediolateral, posteromedial, posteromedian, and posterolateral tibial areas were significantly higher than their normal counterparts. Stress concentration around the boreholes in all finite element models is minimal, with stress values ranging from 0.01 to 3.73 MPa, markedly lower than the 13.93 MPa observed in the undrilled model.

Conclusion: Abnormal stress in the proximal tibia alters the distribution pattern of BMD, and drilling in the sclerotic area is associated with improved prosthesis stability.

Objective: Recently, the MRI-based cervical vertebral bone quality (C-VBQ) scoring system has demonstrated accuracy in reflecting cervical bone quality and predicting postoperative complications from cervical spine surgery. Studies have shown that cervical bone quality is closely linked to loss of cervical lordosis (LCL) after open-door laminoplasty. Additionally, research on lumbar VBQ indicates a strong correlation between lumbar VBQ scores and lumbar paraspinal muscle quality. However, the relationship of C-VBQ score to cervical paraspinal muscles and LCL remains unclear. Therefore, this study aimed to explore the relationship between C-VBQ score and cervical paraspinal muscle-related parameters as well as postoperative LCL, in addition to exploring the risk factors associated with LCL.

Methods: A total of 101 patients who underwent standard C3–C7 open-door laminoplasty at our institution from 2012 to 2022 were included in this study. The LCL group was defined as loss of cervical lordosis > 5° at 1-year postoperative follow-up. Cervical X-rays were obtained to measure the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), T1 slope, and cervical range of motion (ROM). The relative cross-sectional area (RCSA) and degree of fat infiltration (DFF) of the deep cervical extensors, flexors, and all muscles were measured using image J software. Cervical CT Hounsfield unit (HU) and C-VBQ values were measured on preoperative CT and MRI T1-weighted mid-sagittal images, respectively. Then, demographics, cervical sagittal parameters, ROM, paraspinal muscle-related parameters, CT-HU and C-VBQ values were assessed for their correlation with LCL, and multivariate linear analysis was used to determine the risk factors associated with LCL. Finally, the relationship between C-VBQ scores and cervical paraspinal muscle-related parameters was evaluated.

Results: A total of 55 (54.45%) patients were included in the LCL group due to loss of cervical lordosis > 5° at 1-year follow-up. LCL was positively correlated to the preoperative T1 slope, Flexion ROM, C2–7 ROM, Flexion/Extension ROM, Flexion muscles DFF, Extension muscles DFF, Average DFF, and C-VBQ scores, while it was negatively correlated to Extension ROM, Extension muscles RCSA, Total RCSA, and CT-HU values. Furthermore, Flexion/Extension ROM, Total RCSA, Average DFF, CT-HU, and C-VBQ values were independent risk factors for LCL. In addition, C-VBQ scores were significantly correlated with RCSA and DFF of Flexion and Extension muscles.

Conclusions: This study is the first to find a significant correlation between C-VBQ scores and cervical paraspinal muscle quality. The C-VBQ score is a comprehensive indicator that reflects the quality of the cervical bone and paravertebral muscles, and it is a novel predictor of LCL after open-door laminoplasty.

Objective: The degeneration characteristics of adjacent segment disease are complex. Improper surgical planning has caused unnecessary surgical trauma and costs. The purpose of this study was to establish a staging system for adjacent segment disease and evaluate its guiding significance for surgical decisions in adjacent segment disease.

Methods: A retrospective study was performed on 103 patients with adjacent segment disease who underwent treatment between January 2017 and January 2023. Based on radiological findings, adjacent segment disease was categorized into four stages, with no cases identified in Stage IV. Patients were divided into four intervention groups: Group A (control group, traditional posterior lumbar fusion with rod-screw revision), Group B (Stage I, percutaneous endoscopic decompression), Group C (Stage II, oblique lumbar interbody fusion), and Group D (Stage III, cortical bone trajectory screws with posterior lumbar interbody fusion). Clinical and radiological outcomes were evaluated postoperatively, at 3 months, and at 12 months. Statistical analysis was conducted using t-tests, Mann–Whitney U tests, chi-square tests, and Spearman's correlation.

Results: Surgical expenses, duration, estimated blood loss, postoperative hospital stays, disc height index, and Pfirrmann grading all demonstrated significant correlations with the established grading system (p < 0.05). Patients achieved favorable clinical outcomes. Specifically, Groups B, C, and D showed earlier functional recovery compared to Group A, with Groups B and C experiencing more rapid relief from low back pain. Furthermore, Groups B, C, and D had shorter surgical times and reduced blood loss, while Groups B and C also incurred lower surgical costs and shorter hospital stays (p < 0.05).

Conclusion: The new grading system, developed based on the characteristics of adjacent segment degeneration, showed excellent surgical adaptability, despite varying degrees of correlation across different factors. This system was closely linked to the degree of intervertebral disc degeneration and the intervertebral disc height index. All patients achieved favorable surgical outcomes, suggesting that this grading system could provide valuable guidance in making surgical treatment decisions.

Objective: Considering the high incidence and complexity of unstable posterior pelvic ring fractures, and the need for less invasive and more effective treatment options, this study aims to introduce a novel minimally invasive, safe, and simple internal fixation method for the treatment of unstable posterior pelvic ring fractures using the sacroiliac joint locking plate (SJP) system, and to provide biomechanical validation and clinical evaluation of this method.

Methods: Biomechanical research was conducted using standard pelvic bone models from Synbone, Switzerland, to create Denis II zone unstable posterior pelvic ring fracture models, and to assess the stability of the SJP under different loads compared with traditional fixation methods. A retrospective clinical study analyzed the clinical efficacy of SJP treatment in 62 patients (mean age of 51.7 ± 11.9 years and male-to-female ratio of 42/20) treated at our hospital from October 2016 to January 2023.

Results: Biomechanical tests showed that at a maximum load of 300 N, the displacement values for the SJP (3.361 ± 0.246 mm) and two iliosacral (IS) screws (3.325 ± 0.335 mm) were significantly lower than those for a single IS screw (4.281 ± 0.399 mm) and tension band plate (TBP) (4.678 ± 0.534 mm). In the stiffness test of the compression-separation experiment, the average stiffness of the SJP (92.09 ± 1.17 N/mm) was higher than that of a single IS screw (80.06 ± 2.57 N/mm) and TBP (71.67 ± 1.12 N/mm) (p < 0.05 for both), but lower than that of two IS screws (104.94 ± 1.16 N/mm) (p < 0.05). Clinically, postoperative pain scores decreased to 1.9 ± 0.9 after SJP surgery, which was a significant reduction compared with the preoperative score of 9.1 ± 1.1. Functional prognosis scores improved from 36.1 ± 11.5 preoperatively to 88.4 ± 14.2, showing a marked improvement. The postoperative Majeed scores for the patients were 87.4 ± 8.1, and the incidence of complications was low, with only one case reported so far.

Conclusion: The SJP demonstrates robust stability in biomechanical experiments, making it highly advantageous for clinical applications and widespread adoption. It offers several benefits, including straightforward surgical operation, minimal risk of vascular and neural injury, low surgical requirements, and eliminates the need for fluoroscopy. These advantages contribute to its remarkable clinical efficacy and potential for extensive utilization.

Objective: Orthopedic implants may need to be removed for various reasons. There is little data on the appropriate handling of implants after their removal from patients. This study aimed to analyze how orthopedic surgeons handle removed implants and their underlying philosophies, using data collected from a survey.

Methods: This study, conducted between May 2024 and June 2024, utilized an online survey targeting orthopedic surgeons and residents in Turkey to investigate practices and views regarding removed implants. A total of 205 participants completed an 11-question online survey via Google Forms. The survey covered hospital types, professional experience, protocols for handling removed implants, practices for archiving and disposing of implants, and perspectives on current practices and future direction.

Results: Participants' professional experience varied widely. None of the participants followed a specific protocol for managing removed implants. Opinions on giving implants to patients were diverse: 17.1% would never give the implant to the patient, 32.2% would comply with the patient's request, and 50.7% had no definitive approach. A minority (2.9%) systematically archived implants, while others archived selectively or disposed of them as medical waste. The primary motivations for archiving included medicolegal protection (21%) and professional curiosity (75.2%). Only 2.9% had experience with legal requests for removed implants, and 80% supported establishing regulations for handling removed implants.

Discussion: Orthopedic surgeons' legal and ethical perceptions regarding removed implants, as well as their preference of handling, vary widely. Establishing a standardized approach can reduce this variability in practice and ensure uniformity in healthcare.

Objective: Lateral compression II (LC-II) fractures, a common type of pelvic injury, often require closed reduction and percutaneous screw fixation due to posterior pelvic ring instability. However, existing methods fail to adequately account for the internal structure of the screw path and lack precise anatomical guidance, increasing surgical risks. This study utilized digital medical software to analyze the LC-II screw path and entry parameters, providing the anatomical references.

Methods: This retrospective study enrolled 43 adult patients (21 males and 22 females) who underwent a complete computed tomography (CT) scan examination from February 2017 to February 2019. The digital three-dimensional (3D) pelvic model was reconstructed, and the ideal LC-II screw path was designed by the cross-section method. The primary evaluation parameters included the screw path length (D_AP), maximum diameter (D_max), distances at narrow points (D1 and D2), bone thickness parameters (OW1 and IW1; OW2 and IW2), and screw entry angles (∠α, ∠β, ∠γ).

Results: Of 43 patients, 42 successfully completed LC-II screw path construction. Among 21 female patients, 5 (23.8%) could accommodate screws with a maximum diameter of < 6.5 mm. Compared with female patients, male patients exhibited significantly higher D_AP, D_max, D₂, OW₁, IW₁, IW₁/OW₁, and IW₂/OW₂ (p < 0.05). The ∠γ was significantly lower in male patients. Furthermore, digital 3D pelvic model observations revealed that LC-II screws bone entry points in the anterior iliac region were all located posterior to the anterior inferior iliac spine (AIIS). The angles between the LC-II screw and coronal plane were 48.06° in males and 45.10° in females, while the angles between the LC-II screw and sagittal plane were 27.14° and 25.60°, respectively.

Conclusion: This study utilized digital medical software to construct the LC-II screw path and analyze sex-based differences, highlighting the importance of individualized preoperative path planning and providing essential anatomical evidence for the precise and safe percutaneous insertion of LC-II screws.

Background: Thoracolumbar fractures, especially burst fractures, are common severe spinal injuries requiring surgery. The main goals are to restore spinal stability and normal curvature, relieve nerve compression, and prevent further neurological damage. Minimally invasive techniques are increasingly used in spinal surgery. This study aims to use finite element analysis to compare two new thoracolumbar anterior fixation systems: Hybrid cross-thoracolumbar fixation system and new hybrid cross-thoracolumbar fixation system (HXTL and NHXTL) with Medtronic's ANTERIOR system, providing a theoretical reference for surgeries.

Method: A finite element model of the T12–L2 vertebrae of a 27-year-old healthy male was built based on CT images. The model was processed, optimized, meshed, and analyzed using software. In vitro biomechanical tests were compared with the finite element model results to verify the model's validity. A 500 N compressive load and a 10 N m bending moment were applied to the upper surface of T12. The stress and displacement of the vertebral body and the stress state of the support body of the two models under various conditions like forward flexion and backward extension were observed and analyzed.

Results: The study compared the biomechanical performance of the HXTL, NHXTL, and ANTERIOR systems under six physiological conditions. The vertebral body displacement of the three systems was maximum under forward flexion. During right flexion, the HXTL displacement was significantly greater than that of the ANTERIOR and NHXTL systems, while during extension, the HXTL and NHXTL displacements were significantly less than those of the ANTERIOR system. Under other motion conditions, the displacements were relatively small. In terms of vertebral body stress, the ANTERIOR model had the maximum stress during left flexion, significantly greater than that of the other two. In terms of titanium mesh stress, the HXTL system had significantly higher stress during extension and left rotation compared to the other two systems. In terms of nail–rod stress, the ANTERIOR system had higher stress in all directions than the HXTL and NHXTL systems.

Conclusion: Compared with the ANTERIOR system, the HXTL system reduces the surgical incision through oblique nail placement, can reduce the risk of nail–rod failure, and increase the stability of the titanium mesh between vertebral bodies, but it also brings a higher risk of subsidence. The NHXTL model not only reduces the surgical incision and the risk of accidental injury to contralateral blood vessels but also reduces the risk of nail–rod failure and does not increase the risk of titanium mesh subsidence. It is a more optimized choice.

Objective: With the advancement of digital orthopedics, the growing prevalence of medial compartment knee osteoarthritis (MCKOA) and the widespread adoption of knee-preserving surgical techniques have heightened new interest in predicting the onset of MCKOA and promoting surgical outcomes. This study was to clarify the differences in kinematics and contact patterns between the MCKOA knee and its native sides during knee extension.

Methods: From March 2023 to June 2024, thirty-two patients who suffered from unilateral MCKOA, with their contralateral extremities asymptomatic and intact, were enrolled in this descriptive research. Three-dimensional models were created from computed tomography scans, and all patients performed continuous stair climbing under the surveillance of a dual fluoroscopic imaging system (DFIS) to determine the accurate 6-degrees-of-freedom (6-DOF) of their medial OA knees and the contralateral knees. The volume penetration centers between tibial and femoral cartilage models were defined as contact centers. All measured parameters were tested for significant differences using the Wilcoxon Rank-Sum test.

Results: Compared to native knees, the MCKOA tibia showed increased flexion (mean 3.6°) and varus rotation (mean 1.6°), with more posterior (mean 1.4 mm), lateral (mean 1.2 mm) and proximal translations (mean 0.5 mm) relative to the femur during extension (p < 0.05). The tibiofemoral contact patterns on the medial and lateral tibial plateau of the MCKOA knee both shifted more medially (mean 1.4 mm and 1.3 mm, respectively, p < 0.05) than the native side, which was consistent with the lateral translations observed in 6-DOF.

Conclusion: Our findings offer valuable insights into the in vivo kinematics of MCKOA knee, its tibiofemoral joint (TFJ) and contact pattern. In MCKOA knees, the tibia exhibited increased flexion and varus rotation, along with more posterior, lateral, and proximal translation relative to the femur compared to the native side during extension. These changes aligned with the more medial shifts in contact patterns of the tibial plateau on the MCKOA side. These findings provide data support for the digital diagnosis and treatment of MCKOA.

Background: Previous studies on Activities of Daily Living (ADL) suggest that the wrist demonstrates different ranges of motion and frequencies in various directions. However, the specific directional characteristics of wrist activities remain unexplored. This study aims to investigate the directional characteristics of wrist motions during ADL with optical motion capture technology.

Method: This is a basic science study. Twenty-six right-handed subjects executed 22 ADLs, with angular wrist positions tracked via retroreflective markers on the dominant limb. The Cartesian coordinate system formed by wrist flexion–extension and radial–ulnar deviation angles was transformed into a polar coordinate system, enabling the directional analysis and the calculation of the directional range of motion (ROM). The directional distribution of trajectory points was analyzed using the Rayleigh test and visualized. The values and trends of directional RoM in 72 directions for both aggregated and individual ADLs were examined. The peaks of ROMs across ADLs were clustered using K-means to identify key directions. Differences in gender and age were analyzed with a two-way ANOVA.

Result: The trajectories exhibited a strong directional preference across all ADLs (p < 0.01). In the majority of ADLs, the trajectories favored the ulnar extension direction (19/22) and were distributed along the radial flexion–ulnar extension plane (12/22). ROM was calculated for each of the 72 directions in each ADL. The aggregated ADL analysis provided the directional functional ROM (fROM). Three types of ADLs were identified, each with 1, 2, and 3 peaks in their directional ROM, respectively. Three key directions were identified as clusters of peak ROMs in the ADLs. Comparisons across gender and age groups revealed varying preferences for directional ROM in each group.

Conclusion: This study identified three key wrist motion directions essential for daily functions, highlighting the critical role of ulnar extension. Additionally, it demonstrated variations in directional wrist motion preferences across different genders and age groups.

Objective: Currently, quality criteria for reduction after femoral neck fractures such as the Garden index are mainly based on two-dimensional x-rays. Research shows that current reduction quality criteria are no longer sufficient to meet the needs to reduce the incidence of osteonecrosis of the femoral head (ONFH). The purpose of this study is to construct a reduction quality criterion based on spatial residual displacements of 3D reconstruction and to predict the occurrence of ONFH.

Methods: The subjects were from the Tianjin Hospital Hip Fracture cohort, all of whom experienced femoral neck fractures and underwent reduction and internal fixation at Tianjin Hospital and received 12 months of follow-up minimally postoperatively. CT scans were used for 3D reconstruction, and six spatial displacement indicators were measured. Risk factors of ONFH were identified using logistic regression, and a reduction quality criterion based on spatial residual displacements was constructed. Multivariate logistic regression models were performed to estimate the effect of reduction quality by the new criterion on ONFH.

Results: Data from 391 patients were included in the final analysis. Preoperative displacement of the center of the femoral head (CFH), postoperative residual displacement of the CFH, and residual rotational displacement were proved to be independent risk factors for ONFH, with OR values of 3.83 (95% CI: 1.98, 7.48), 2.62 (95% CI: 1.05, 6.49), and 5.36 (95% CI: 2.46, 11.64), respectively. The new criterion was composed of two indicators and had three grades: when residual displacement of CFH is ≤ 4.075 mm, and residual rotational displacement of femoral head is ≤ 18.595°, the quality is excellent; when residual displacement of CFH is ≤ 4.075 mm and residual rotational displacement of femoral head is > 18.595° or when residual displacement of CFH is > 4.075 mm and residual rotational displacement of femoral head is ≤ 18.595°, the quality is moderate; when residual displacement of CFH is > 4.075 mm and residual rotational displacement is > 18.595°, the quality is poor. The risk of ONFH would increase 3.99 times (95% CI: 2.35, 6.78) for each lower grade in reduction quality. The logistic regression model was well discriminated with an AUC area of 0.802 and had good calibration with a p-value of > 0.05 by the Hosmer–Lemeshow test.

Conclusion: A new reduction quality criterion for femoral neck fracture based on CT was constructed, and reduction quality before fixation by the new criterion was proved to be an independent predictive factor for ONFH. The logistic regression model had quite good discrimination and calibration for postoperative ONFH.

Objective: Distal radius fractures account for 12%–17% of all fractures, with accurate classification being crucial for proper treatment planning. Studies have shown that in emergency settings, the misdiagnosis rate of hand/wrist fractures can reach up to 29%, particularly among non-specialist physicians due to a high workload and limited experience. While existing AI methods can detect fractures, they typically require large training datasets and are limited to fracture detection without type classification. Therefore, there is an urgent need for an efficient and accurate method that can both detect and classify different types of distal radius fractures. To develop and validate an intelligent classifier for distal radius fractures by combining a statistical shape model (SSM) with a neural network (NN) based on CT imaging data.

Methods: From August 2022 to May 2023, a total of 80 CT scans were collected, including 43 normal radial bones and 37 distal radius fractures (17 Colles', 12 Barton's, and 8 Smith's fractures). We established the distal radius SSM by combining mean values with PCA (Principal Component Analysis) features and proposed six morphological indicators across four groups. The intelligent classifier (SSM + NN) was trained using SSM features as input data and different fracture types as output data. Four-fold cross-validations were performed to verify the classifier's robustness. The SSMs for both normal and fractured distal radius were successfully established based on CT data. Analysis of variance revealed significant differences in all six morphological indicators among groups (p < 0.001). The intelligent classifier achieved optimal performance when using the first 15 PCA-extracted features, with a cumulative variance contribution rate exceeding 75%. The classifier demonstrated excellent discrimination capability with a mean area under the curve (AUC) of 0.95 in four-fold cross-validation, and achieved an overall classification accuracy of 97.5% in the test set. The optimal prediction threshold range was determined to be 0.2–0.4.

Results: The SSMs for both normal and fractured distal radius were successfully established based on CT data. Analysis of variance revealed significant differences in all six morphological indicators among groups (p < 0.001). The intelligent classifier achieved optimal performance when using the first 15 PCA-extracted features, with a cumulative variance contribution rate exceeding 75%. The classifier demonstrated excellent discrimination capability with a mean AUC of 0.95 in four-fold cross-validation and achieved an overall classification accuracy of 97.5% in the test set. The optimal prediction threshold range was determined to be 0.2–0.4.

Conclusion: The CT-based SSM + NN intelligent classifier demonstrated excellent performance in identifying and classifying different types of distal radius fractures. This novel approach provides an efficient, accurate, and automated tool for clinical fracture diagnosis, which could potentially improve diagnostic efficiency and treatment planning in orthopedic practice.

Objective: Arthroscopic repair of upper one-third subscapularis tendon tears remains challenging due to suture management difficulties and repair quality limitations. We proposed a simpler knotless technique—the H-Loop technique. This study evaluates its early clinical and imaging outcomes.

Method: This is a case series of 38 patients (9 males and 29 females), who underwent arthroscopic H-Loop technique repair for upper one-third subscapularis tendon tears between January 2021 and August 2023. Postoperative assessments include the American Shoulder and Elbow Surgeons (ASES) score, the University of California, Los Angeles (UCLA) shoulder score, the Constant-Murley score, the visual analog scale (VAS), range of motion (ROM) (internal and external rotation), and internal rotation strength. In addition, MRI (30 patients) evaluated fatty infiltration, re-tears, and subscapularis integrity, comparing tendon dimensions and signal-to-signal ratios with a control group of patients with normal subscapularis tendons.

Result: Preoperative symptom duration ranged from 3 to 36 months, with an average of 9 months. Follow-up ranged from 12 to 14 months, with an average duration of 12.6 months. No complications were observed in any patient. Postoperative ASES scores increased significantly compared to preoperative scores (55.63 ± 15.85 vs. 88.92 ± 8.24), as did UCLA scores (21.82 ± 4.44 vs. 29.74 ± 3.55) and Constant-Murley scores (69.76 ± 15.30 vs. 86.34 ± 14.48). VAS scores decreased significantly (5.16 ± 1.84 vs. 0.89 ± 0.76). Postoperative ROM showed significant improvement in internal rotation (7.79 ± 2.07 vs. 8.45 ± 1.33) and external rotation (57.63° ± 15.84° vs. 66.58° ± 9.08°) (p < 0.05). Internal rotation strength ratios increased markedly (78.00% ± 15.86% vs. 91.97% ± 6.62%). MRI indicated no re-tears or fatty infiltration in the 30 patients, and compared to the control group, there were no statistically significant differences in the vertical diameter of the subscapularis muscle (62.89 mm ± 9.30 mm vs. 59.41 mm ± 7.55 mm; p = 0.153), transverse diameter of the upper subscapularis muscle (17.82 mm ± 3.79 mm vs. 19.43 mm ± 4.76 mm; p = 0.395), transverse diameter of the lower subscapularis muscle (24.09 mm ± 5.84 mm vs. 25.23 mm ± 5.41 mm; p = 0.870), cross-sectional area of the subscapularis muscle (1338.54 mm² ± 277.26 mm² vs. 1247.94 mm² ± 210.55 mm²; p = 0.098), signal-to-signal ratio of the upper subscapularis muscle (1.18 ± 0.28 vs. 1.24 ± 0.28; p = 0.792), or the signal-to-signal ratio of the lower subscapularis muscle (1.02 ± 0.24 vs. 1.03 ± 0.16; p = 0.128).

Conclusion: The arthroscopic H-Loop technique significantly restores function, improves range of motion, and enhances internal rotation strength, maintaining good tendon integrity in the early postoperative period.

Objective: Severe destruction of the wrist joint after trauma, disease, or iatrogenic causes can lead to significant bone defects and deformities, limiting the options for surgeries. Bespoke 3D-printed metal prostheses were designed and used for four patients. This study aimed to describe the design rationale and report the clinical outcomes.

Methods: Between 2022 and August 2024, we followed up on four patients with significant bone defects and deformities caused by various factors, who opted against arthrodesis. These patients were treated with customized 3D-printed prostheses replacements. All cases underwent assessment through clinical and radiological examinations, evaluating parameters including passive range of motion (ROM) of the wrist, grip strength, VAS of pain, and functional scales such as the Mayo score, Patient-Rated Wrist Evaluation (PRWE), and Quick Disabilities of the Arm, Shoulder, and Hand (quick DASH) score. A paired t-test was conducted to compare pre- and postoperative outcomes.

Result: The mean follow-up period lasted 11.9 ± 6.7 months (range 6–18 months). All patients reported satisfying pain relief and enhanced function. The average ROM was 23.3° ± 5.7° of extension and 27.0° ± 18.6° of flexion. The average VAS score of pain was 1.5. The mean Mayo score, PRWE, and Quick DASH were 60.0, 31.5, and 28.3, respectively. No complications such as loosening, dislocation, or infection were observed during the follow-up period.

Conclusions: Customized 3D-printed prosthetic replacements for severely destroyed wrists can provide good functional outcomes with a higher satisfaction rate.

Level of Evidence: IV.