Background and Objectives: Total knee arthroplasty (TKA) is a standard treatment for end-stage knee osteoarthritis (KOA). While conventional TKA (cTKA) is widely used, robotic-assisted TKA (rTKA) has gained attention for its potential precision and improved outcomes. However, the comparative efficacy and safety of rTKA versus cTKA remain unclear due to inconsistent findings in existing studies. This study aims to systematically review and compare the efficacy and safety of rTKA and cTKA in patients with KOA.

Methods: A total of seven databases were searched. Only randomized controlled trials (RCTs) were included in this systematic review. Subgroup analysis, sensitivity analysis, and trial sequential analysis (TSA) were used to evaluate the stability of the results.

Results: Twenty-five RCTs involving 3156 patients with KOA were included. The only statistically significant clinical difference between patients who received rTKA and cTKA was that the rTKA group was associated with a longer operative duration (MD = 22.38 mins; 95% confidence interval [CI] [12.86, 31.91]; p < 0.00001; I² = 98%). As for functional parameters, the two groups had similar results in postoperative Knee Society Score (KSS), the Western Ontario and McMaster Universities (WOMAC), and Hospital for Special Surgery Score (HSS). Regarding the tibiofemoral angle and the coronal femoral component angle, no significant difference was observed between the two groups. Patients in the rTKA group had a higher hip–knee–ankle angle (HKA) (MD = 0.63; 95% CI [0.23, 1.03]; p = 0.002; I² = 52%), lower HKA deviation (MD = −0.99; 95% CI [−1.24, −0.74]; p < 0.00001; I² = 0%), and a higher coronal tibial component angle (MD = 0.46; 95% CI [0.07, 0.85]; p = 0.02; I² = 81%) after the surgery.

Conclusions: While rTKA appears to be a feasible and safe alternative to cTKA, the mixed evidence from our study highlights the need for further research to fully understand its clinical implications and long-term outcomes.

Trial Registration: PROEPERO: CRD42024541052

Recent literature has increasingly demonstrated the significant function of autonomic nerves in regulating physiological and pathological changes associated with the skeletal system. Extensive studies have been conducted to understand the contribution of the autonomic nervous system (ANS) to skeletal metabolic homeostasis and resistance to aseptic inflammation, specifically from the viewpoint of skeletal neurobiology. There have been plenty of studies on how the sympathetic nervous system (SNS) and parasympathetic nervous system (PNS), the two main branches of the ANS, regulate bone remodeling, which is the process of bone formation and resorption. The following studies have revealed critical neurological pathways that induce significant alterations in bone cell biology and uncover the intricate linkages between the ANS and the skeletal system. Furthermore, inspired by the connection between the ANS and bone remodeling, neuromodulation has been utilized as a therapeutic method for patients with orthopedic diseases: by directly influencing the ANS, it is possible to alter the excitability of nerve fibers and the release of neurotransmitters, which can lead to anti-inflammatory and analgesic effects, thereby directly or indirectly impacting bone formation and bone resorption. Our work aims to review the most recent findings on the impact of the ANS on bone remodeling, enhance the current understanding of the interaction between nerves and bones, and explore potential neuromodulation methods that could be used to treat orthopedic conditions, thereby drawing attention to the significant role of the ANS in the skeletal system.

Background: Total hip arthroplasty (THA) is the gold standard for end-stage hip arthrosis, while hip resurfacing arthroplasty (HRA) is considered a more bone-conserving alternative. This meta-analysis aimed to compare the safety and clinical efficacy of HRA and THA.

Methods: The databases of PubMed, EMBASE, Cochrane Library, and CNKI were searched for RCTs comparing HRA and THA in treating hip arthrosis from database initiation to April 2024. Inclusion and exclusion criteria were defined, and data extraction, quality evaluation, and risk bias assessment were performed. A meta-analysis was conducted using appropriate RevManv5.4 and Stata v14.0 software.

Results: Twenty RCTs from six countries were included. HRA had a similar revision rate, function scores (WOMAC, HSS, OHS, UCLA activity score, EQ-D, EQ-5D VAS), and blood levels of cobalt and chromium compared to THA. HRA had fewer complications and less blood loss but required more operating time.

Conclusions: HRA is a safe and effective alternative to THA, with similar revision and functional outcomes, less blood loss, and is particularly suitable for young male patients with a demand for high-level activities.

Diagnostic imaging in sports medicine includes traditional imaging modalities such as x-ray, computed tomography (CT), and magnetic resonance imaging (MRI). Despite having certain advantages, these imaging techniques often have lower sensitivity and specificity, making it difficult to detect soft tissue injuries and early-stage cartilage damage. They also lack the ability to assess the biomechanical properties and functional states of tissues. Photoacoustic imaging (PAI) offers a powerful, non-ionizing, and cost-effective alternative to traditional imaging techniques in the diagnosis and therapeutic monitoring of sports injuries. PAI combines the benefits of optical imaging and ultrasound to provide high-resolution images of deep tissues, including tendons and ligaments. This technology uses pulsed lasers to irradiate tissues, causing thermal expansion and generating ultrasound waves, which are then captured and converted into images. PAI is particularly adept at depicting blood vessels and soft tissues with high resolution and sensitivity to the optical absorption contrasts of oxy- and deoxyhemoglobin. It can assess tissue oxygenation and metabolic activities, which are crucial for evaluating the healing process in sports injuries. Herein, the role of PAI in sports medicine is assessed and particularly its advantages over traditional imaging methods such as x-rays, CT scans, and MRI scans in diagnosing musculoskeletal injuries.

Osteoarthritis (OA) is a degenerative disease characterized by cartilage abrasion and pain, affecting millions globally. However, current treatments focus on symptom management rather than modifying disease development. Recent studies have indicated that low-density lipoprotein receptor-related protein 1 (LRP1) is associated with maintaining cartilage homeostasis through its involvement in endocytosis and signaling pathways. LRP1 facilitates the removal of extracellular matrix (ECM)-degrading enzymes, including a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTSs) and matrix metalloproteinases (MMPs), thereby protecting against excessive cartilage breakdown. However, OA cartilage shows increased shedding of LRP1, leading to reduced endocytic capacity and elevated levels of these enzymes, contributing to accelerated ECM breakdown. LRP1 is also involved in key signaling pathways, such as Wnt/β-catenin, transforming growth factor-beta (TGF-β), and nuclear factor-kappa B (NF-κB), which regulate processes like chondrocyte proliferation, apoptosis, differentiation, and autophagy. Dysregulation of these pathways, combined with impaired LRP1-mediated endocytosis, fosters a catabolic environment in osteoarthritic cartilage. Emerging therapies targeting LRP1, such as gene interventions, exosome-based therapies, and small-molecule modulators, show potential in restoring LRP1 function, reducing cartilage degradation, and promoting joint repair. This review emphasizes the significance of LRP1 in the development of OA and explores its potential as a therapeutic target for creating disease-modifying strategies to maintain joint integrity and enhance patient well-being.

Objectives: Lumbar spinal stenosis is a common degenerative spine condition that leads to severe pain and disability. Surgical intervention is often required when conservative treatments fail, but the choice between different surgical techniques remains a topic of ongoing debate. The objective of this study was to provide a comprehensive comparison of the safety and efficacy of endoscopic unilateral laminectomy with bilateral decompression (Endo-ULBD) and posterior lumbar interbody fusion (PLIF) in the treatment of multi-segmental lumbar spinal stenosis (MS-LSS). Furthermore, the text provides detailed technical information regarding the Endo-ULBD procedure.

Methods: This retrospective comparative study was conducted from October 2019 to October 2022 and involved 73 patients diagnosed with MS-LSS. Of the total number of patients, 36 were treated with Endo-ULBD and 37 with PLIF. The technical parameters of both procedures were recorded, including perioperative factors such as patient demographic characteristics (age, gender, BMI), disease duration, number of surgical segments involved, type of anesthesia, duration of surgery, estimated blood loss (EBL), postoperative length of stay, time to discharge, use of intraoperative fluoroscopy, and any intraoperative complications. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), the Japanese Orthopedic Association (JOA) score, and the Oswestry Disability Index (ODI), which were assessed preoperatively and at follow-up. Radiologic improvement was quantified by comparing the preoperative and postoperative dural sac areas. Statistical analyses were conducted using paired t tests with a significance threshold of p < 0.05.

Results: In comparison to the PLIF group, the Endo-ULBD group exhibited a markedly shorter operative time, diminished intraoperative bleeding, accelerated recovery of ambulation, and a shorter postoperative hospitalization period. Moreover, the Endo-ULBD group demonstrated a diminished prevalence of postoperative complications. However, it required a significantly greater number of intraoperative x-ray fluoroscopies than the PLIF group (p < 0.05). Postoperative VAS, ODI, and JOA scores demonstrated notable improvement in both groups, with a more pronounced trajectory observed in the Endo-ULBD cohort during the early postoperative period. Both surgical approaches resulted in a notable enlargement of the dural sac area. Neither group experienced any fatalities, irreversible nerve damage, or paralysis.

Conclusion: Endo-ULBD demonstrated superior early clinical outcomes compared to PLIF, including shorter operative time, reduced blood loss, faster recovery, and fewer complications. Both techniques provided similar improvements in dural sac decompression, but Endo-ULBD may offer a more efficient and minimally invasive treatment option for patients with MS-LSS. However, the high frequency of intraoperative fluoroscopy remains a limitation, highlighting the need for improved surgical techniques and positioning systems.

Objective: This study provides a comparative analysis of clinical outcomes between primary and salvage reverse shoulder arthroplasty (RSA), offering valuable insights into the management of proximal humerus fracture (PHF). To evaluate the outcomes of patients treated with RSA as a primary procedure for acute PHF and to compare these with patients undergoing salvage RSA as a revision procedure for fracture sequelae of PHF.

Methods: A retrospective cohort study was conducted on 42 patients undergoing RSA for PHF between December 2014 and April 2022. The primary RSA group (n = 28, mean age 73.8 ± 4.5 years, 66–81 years) included patients with acute fractures, while the salvage RSA group (n = 14, mean age 62.1 ± 12.3 years, 47–83 years) comprised revision cases for fracture sequelae. Active range of motion (ROM), Visual Analog Scale (VAS), Constant score, and American Shoulder and Elbow Surgeons (ASES) scores were assessed for all patients. Outcomes between the two groups were compared, along with radiographic outcomes and complications recorded at each follow-up. Categorical variables were analyzed using chi-square or Fisher's exact tests, while continuous variables were compared using independent t-tests or Mann–Whitney U tests based on data distribution.

Results: At a mean follow-up of 56 months (24–106 months), no significant differences in gender (p = 0.469) or follow-up duration (p = 0.087) were observed. The salvage group exhibited comparable postoperative ROM (anterior flexion (AF): 101.4° ± 52.3° vs. 115.9° ± 29.1°; external rotation (ER): 26.4° ± 16.4° vs. 28.8° ± 14.1°; internal rotation (IR): 7 ± 2 vs. 7 ± 2; all p > 0.05) and clinical scores (VAS: 1.6 ± 1.9 vs. 1.2 ± 1.5; Constant: 74.1 ± 23.3 vs. 79.4 ± 15.9; ASES: 81.9 ± 15.4 vs. 84.0 ± 13.8; all p > 0.05) to the primary group. However, the salvage group demonstrated significant preoperative-to-postoperative improvements in AF (50.9°, p < 0.001), ER (5.4, p = 0.017), and functional scores (VAS: −4.6; Constant: + 36.9; ASES: + 45.8; all p < 0.05). Complications occurred in 14.3% of salvage cases (2 revisions for periprosthetic fracture and aseptic loosening) versus 3.6% in the primary group. No other major complications such as deep infection, instability, acromial stress fracture, or dislocation were recorded.

Conclusion: RSA achieves comparable functional and radiographic outcomes for both acute PHF and fracture sequelae over 4 years of follow-up. Salvage RSA provides substantial clinical improvement but carries a higher complication risk, emphasizing the need for meticulous surgical technique and patient selection.

Objective: Postmenopausal osteoporosis (PMOP) leads to bone loss, fragility, and fractures, causing pain and reduced function. Effective treatment should improve bone mineral density (BMD), prevent fractures, and enhance quality of life. Denosumab is FDA-approved for osteoporosis, but its effects on pain and function in Chinese patients with PMOP remain underexplored. This study investigates the impact and influencing factors of denosumab treatment on pain and function to support a broader evaluation of osteoporosis treatment.

Methods: This prospective study included 200 patients with PMOP, treated at the hospital, between September 2022 and September 2023. Subjects received 60 mg of denosumab subcutaneously, and calcium and vitamin D supplements. Pain (Numerical Rating Scale, NRS), function (Oswestry Disability Index, ODI), bone metabolic markers, and BMD were assessed at baseline, 6, and 12 months posttreatment. Correlations between NRS, ODI, and BMD, and the influencing factors of efficacy differences were analyzed.

Results: (1) Posttreatment, NRS scores and ODI significantly decreased. (2) Posttreatment, bone metabolic markers were significantly lower; BMD of the hip, femoral neck, and lumbar spine significantly increased from baseline but was most significant in the lumbar spine. (3) Changes in NRS and ODI positively correlated with the increase in lumbar spine BMD but not with changes in femoral neck or total hip BMD. ODI reduction was positively correlated with increases in all three sites' BMD. (4) Factors influencing NRS, ODI, and BMD of treatment include the following: patients with prior fragility fractures (mainly vertebral fractures) had greater improvements in NRS, ODI, and lumbar spine BMD than those without a history of fragility fractures; those without previous antiosteoporosis medication had a more significant increase in lumbar spine BMD than those with a history of antiosteoporosis medication use (mainly antiresorptive drugs).

Conclusion: Following 12 months of denosumab treatment in patients with PMOP and increasing BMD, there was a significant improvement in pain and functional disability. The improvement in pain was closely related to the increase in lumbar spine BMD, while functional enhancement was strongly associated with BMD gains in the total hip, femoral neck, and lumbar spine. Age, weight, and osteoporosis severity do not affect treatment response. Patients with prior fragility fractures (mainly vertebral fractures) experienced more significant improvements in pain symptoms and functional outcomes. Denosumab resulted in a more significant increase in BMD in patients with a history of fragility fractures (mainly vertebral fractures) and those without a history of antiosteoporosis medication use.

Objective: Current classifications inadequately address distal clavicle fracture instability due to their coronal plane focus, neglecting multiplanar displacement and underestimation of complexity on routine radiographs. This study aimed to bridge this gap by employing three-dimensional (3D) fracture mapping to characterize injury patterns, offering mechanistic insights to optimize surgical strategies.

Methods: A retrospective analysis was conducted on 81 patients diagnosed with acute distal clavicle fractures at Wuxi Ninth People's Hospital between 2019 and 2022. Axial and sagittal CT planes were utilized to demonstrate fracture line alignment. Manual simulated repositioning was performed for all fracture lines, which were subsequently graphically superimposed onto a standard template of the intact distal clavicle. A 3D map was generated and subsequently transformed into a heatmap. The classification of distal clavicle fractures was determined based on the updated and modified Neer classification. Two points were designated at the distal end of the fracture block and at the repositioned counterpart to assess the three-dimensional spatial position, including shortening along the x-axis, horizontal displacement along the y-axis, vertical displacement along the z-axis, as well as the displacement angles in the three planes, thereby quantifying the displacement of each distal clavicle fracture.

Results: This study included 81 cases of distal clavicle fractures (43 cases on the left side and 38 cases on the right side). The distribution included 8 cases (9.88%) of Neer I, 5 cases (6.17%) of Neer IIA, 31 cases (38.27%) of Neer IIB, 11 cases (13.58%) of Neer IIC, 14 cases (17.28%) of Neer III, and 12 cases (14.81%) of Neer V. Fracture mapping revealed that the fracture lines were predominantly located in the distal one-third of the distal clavicle, with the highest concentration at the acromion end. The majority of displaced distal clavicle fractures exhibit multidirectional displacement, mainly posterior, superior, and shortening, along with angulation in the corresponding directions.

Conclusions: Most displaced distal clavicle fractures involve multiple displacements and angulations, necessitating three-dimensional analysis during fracture reduction. A comprehensive 3D assessment of displacement patterns is essential for evaluating stability and guiding treatment. Fracture line analysis further enhances classification accuracy and informs imaging protocols and fixation strategies tailored to specific fracture types.

Objective: The osteotomy surgery for ankylosing spondylitis (AS) presents a higher risk of dural injury and cerebrospinal fluid leakage compared to conventional spinal surgical procedures. However, there is currently a lack of systematic summaries in this field. This study aims to present the incidence and risk factors associated with dural tears and cerebrospinal fluid (CSF) leakage during corrective osteotomy procedures for AS with kyphotic deformity.

Methods: A retrospective analysis was conducted on patients diagnosed with AS in our hospital between June 2014 and May 2024 who presented with kyphotic deformity and underwent corrective osteotomy, specifically pedicle subtraction osteotomy (PSO) or Smith-Petersen osteotomy (SPO). A total of 110 patients were included in this investigation. Among them, 98 patients underwent PSO (69 received single-segment PSO; 29 received double-segment PSO), while 12 patients underwent SPO. The mean age of the participants at the time of surgery was 36.25 years (ranging from 21 to 59 years). Of the total cohort, intraoperative dural tears occurred in 37 patients. Radiological parameters—including sagittal vertical axis (SVA), total kyphosis angle, posterior epidural space thickness at the PSO segment, sagittal alignment of the vertebral canal at the PSO segment, Andersson lesions, and dural ossification—were assessed using spine radiographs or computed tomography (CT) scans analyzed via Surgimap software. The continuous variables mentioned above were primarily compared between groups using independent samples t test, while categorical variables were mainly analyzed through the chi-square test or Fisher's exact test for intergroup comparisons. Additionally, binary logistic regression was employed to further validate the risk factors associated with cerebrospinal fluid leakage in patients undergoing PSO osteotomy.

Results: The overall incidence of dural tears was found to be 33.6%. Specifically, the incidence during PSO procedures was recorded at 36.4%, whereas it was only 9.1% for SPO procedures. The upper lumbar PSO is the surgical segment with the highest probability of dural tears during PSO procedures. This study summarizes the imaging characteristics of patients undergoing PSO, revealing that those who experience dural tears and CSF leakage typically present with a smaller thickness of the epidural space at the osteotomy site and a higher prevalence of Andersson lesions and dural ossification. A multiple linear regression model indicates that reduced thickness of the epidural space at the osteotomy site, along with Andersson lesions and dural ossification, are significant risk factors for dural tears and CSF leakage following PSO surgery.

Conclusion: The total accidental dural tears rate in osteotomy surgery for AS is 33.6%. PSO presents a higher risk compared to SPO procedures. Factors such as the thickness of the posterior epidural space at the PSO segment, Anderson lesions, and dural ossification observed in CT scans serve as predictors for dural tears during PSO procedures. A comprehensive preoperative CT imaging assessment can provide valuable guidance regarding the potential occurrence of accidental dural tears and CSF leakage.

Objective: Degenerative lumbar scoliosis (DLS) often requires surgical intervention, but traditional posterior-only approaches, despite their effectiveness, result in significant muscle damage and high complication rates. Minimally invasive techniques like oblique lumbar interbody fusion (OLIF) and the Wiltse approach are preferred for preserving posterior structures. However, the lack of controlled studies comparing combined approaches to traditional methods limits their efficacy evaluation. The purpose of this study is to explore the clinical and radiological outcomes of OLIF with posterior fixation through Wiltse approach versus a posterior-only approach in treating DLS.

Methods: This retrospective study included 88 DLS patients underwent surgery from January 2019 to September 2021. The patients were divided into the OLIF group (n = 32) and the posterior group (n = 56). Comprehensive evaluations of clinical and radiological outcomes, including Cobb angle, coronal balance distance (CBD), sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were conducted, with a subsequent subgrouping of OLIF group based on preoperative sagittal vertical axis (SVA) into Subgroup A (SVA ≤ 50 mm) and Subgroup B (SVA > 50 mm) for further analysis. The t-test or Wilcoxon's rank sum test is used to compare continuous variables, and the chi-square test is used to compare categorical variables.

Results: The OLIF group had fewer fixation levels (4.25 ± 1.08 vs. 5.56 ± 2.04, p < 0.001) and shorter hospitalization (5.22 ± 2.25 d vs. 6.66 ± 2.16 d, p < 0.001), fewer drainage volume (371.94 mL vs. 1065.25 mL, p < 0.001), but longer surgical time. Postoperatively, the OLIF group showed better clinical outcomes. In both groups, Cobb angle, coronal balance distance, and sagittal spinal pelvic parameters improved significantly. The OLIF group achieved a lower SVA (23.84 mm ± 36.70 mm vs. 42.84 mm ± 36.25 mm, p = 0.027), which was not maintained at the final follow-up. Subgroup A maintained sagittal balance (34.55 mm ± 24.99 mm vs. 83.73 mm ± 61.90 mm, p = 0.029). Moreover, the OLIF group had fewer complications.

Conclusion: Minimally invasive multi-level OLIF with posterior fixation through Wiltse approach, as compared to the conventional posterior approach, has fewer fixation segments, offers comparable radiographic outcomes and, more importantly, superior clinical results. In addition, patients with a preoperative SVA > 50 mm could benefit from more fixation levels to maintain sagittal balance.

Objectives: Pelvic bone tumor resection and reconstruction present significant challenges due to complex anatomy and weight-bearing demands. 3D-printed hemipelvic prostheses, incorporating customized osteotomy guides and porous structures, offer a promising solution for enhancing osseointegration. This study evaluates the long-term outcomes of 3D-printed custom hemipelvic reconstruction with a focus on the integration of auxetic biomaterials with a negative Poisson's ratio to optimize mechanical properties.

Methods: A retrospective analysis was conducted on 12 patients with primary pelvic malignancies who underwent reconstruction using 3D-printed hemipelvic prostheses between January 2018 and May 2023. Follow-up duration was 48 months (range, 29–64 months) Oncological, functional, surgical, pain control, and radiographic outcomes were assessed.

Results: At the latest follow-up, 8 patients (66.7%) were disease-free, 3 (25%) had disease progression, and 1 (8.3%) died from metastatic complications. Functional outcomes improved significantly, with the MSTS-93 score increasing from 15 (range, 12–17) to 26 (range, 21–29). Pain scores decreased from 5 (range, 4–7) to 1 (range, 0–2). The median surgical duration was 270 min (range, 150–560 min), with intraoperative blood loss averaging 3200 mL (range, 1900–6300 mL). Complications included poor wound healing in 2 patients (16.7%), managed with VAC drainage. No mechanical failures, loosening, or fractures occurred. Accurate osteotomy, prosthesis implantation, and screw fixation were achieved. Successful osseointegration was observed in all cases, with no signs of bone absorption or osteolysis.

Conclusions: 3D-printed custom hemipelvic prostheses with auxetic biomaterials offer an effective solution for pelvic reconstruction, providing promising oncological, functional, and radiographic outcomes. These findings support the use of 3D printing in complex pelvic defect reconstruction, optimizing both osteointegration and mechanical strength.

Objectives: For children aged 18 months and above with developmental dysplasia of the hip (DDH), treatment typically involves open reduction and hip reconstruction surgery. However, there is limited literature evaluating the efficacy of closed reduction in this patient population. The purpose of this study was to investigate the clinical efficacy of closed reduction and spica cast immobilization treatment for children aged 18 months and above with DDH, as well as the incidence of avascular necrosis of the femoral head (ANFH) and their associated risk factors.

Methods: We retrospectively reviewed all children aged 18 months and above undergoing closed reduction and spica cast immobilization for DDH in our institution from January 2014 to December 2020. We found 51 hips suffered from closed reduction failure and identified 51 hips with successful closed reduction that matched the hips in the failure group in terms of age (difference < 1 month), weight (difference < 2 kg), and same gender. For patients with bilateral DDH, we prioritized self-matching, pairing the failed side with the successfully treated side. Relevant clinical data were collected and compared between the two groups. Multiple analyses of risk factors for closed reduction failure and ANFH were conducted by logistic regression.

Results: In all, 61 patients (102 hips) were included in our study, 2 boys and 59 girls. Compared with the success group, the failure group more commonly had a higher International Hip Dysplasia Institute (IHDI) classification (Type III: 23.53% vs. 15.69%; Type IV: 60.78% vs. 23.53%, p < 0.001), a higher preoperative acetabular index (AI) index (39.42 ± 5.50 vs. 34.03 ± 6.15, p < 0.001), and a higher preoperative migration percentage (MP) (0.81 ± 0.27 vs. 0.54 ± 0.36, p < 0.001). Adjusting for other factors, the IHDI classification Types III–IV was the independent factor associated with closed reduction failure. Compared with the IHDI classification Type I, the failure risk of Type III and Type IV was increased 16.87 and 52.13 times, respectively (p < 0.05). ANFH was observed in three patients (4 hips, 4/102, 3.92%). All cases of ANFH occurred in the closed reduction failure group. The higher preoperative MP was related to the ANFH occurrence significantly through the unilateral factor analysis (0.98 ± 0.05 vs. 0.66 ± 0.34, p < 0.001). Adjusting for other factors, we did not find any independent factor regarding the ANFH occurrence (p > 0.05).

Conclusions: For patients aged 18 months and above with DDH, an IHDI classification assessment is necessary before closed reduction and spica cast immobilization. For patients classified as IHDI classification Types III and IV, active consideration of open reduction is advisable.

Objective: O-arm navigated MIS-TLIF is one of the novel surgical techniques for treating lumbar spondylolisthesis, but there still lacks enough evidence regarding intraoperative facet joint violation (FJV) and postoperative facet joint degeneration (FJD). This study aimed to compare clinical outcomes, accuracy of screw placement, and supradjacent FJV between the O-arm navigated MIS-TLIF group (NavMIS-TLIF group) and the open-TLIF group for the treatment of low-grade lumbar spondylolisthesis, and further, to investigate the risk factors influencing FJD.

Methods: We retrospectively reviewed a cohort of patients with low-grade lumbar spondylolisthesis who had received O-Arm navigated MIS-TLIF or open TLIF from May 2018 to May 2023. All the patients were followed up for at least 1 year. The demographic and perioperative data were recorded. The ODI and VAS scores were collected before surgery, 3 months postoperatively, and at the final follow-up. Slip parameters were measured before surgery and at the last follow-up. The screw convergence angle at the upper instrumented vertebra was evaluated based on postoperative CT images. Accuracy of screw placement and supradjacent FJV were assessed after surgery. The FJD was assessed at the final follow-up in comparison to that before surgery.

Results: Each group had 42 patients. VAS back pain of the NavMIS-TLIF group at the 3-month follow-up was lower than that of the open-TLIF group, yet there was no significant difference in ODI and VAS scores between the groups at the final follow-up. Both groups had similar slip reduction results. The clinically accurate rate of screw placement in the NavMIS-TLIF group was 99.4%, significantly higher than 94.0% in the open-TLIF group. At the upper instrumented vertebra, the screw convergence angle of the NavMIS-TLIF group was significantly larger than that of the open-TLIF group. The incidence of FJV in the NavMIS-TLIF group (23.8%) was significantly lower than that in the open-TLIF group (53.6%). There was no significant difference in preoperative FJD between the two groups, while at the last follow-up, the open-TLIF group had more cases of FJD. The screw convergence angle had a negative correlation with FJV and the aggravation of FJD, and FJV was positively associated with the aggravation of FJD. Multivariable logistic regression showed that FJV served as an independent risk factor for the aggravation of FJD.

Conclusions: O-arm navigated MIS-TLIF has similar clinical outcomes and higher accuracy of screw placement compared to open TLIF. O-arm navigated MIS-TLIF reduces the incidence of FJV significantly, which probably helps to delay FJD.

Objective: Adjacent vertebral fracture (AVF) is a commonly observed complication in patients with osteoporotic vertebral compressive fractures (OVCF) following percutaneous kyphoplasty (PKP). The primary etiology of this complication is the deterioration of the biomechanical environment. Local kyphotic deformity plays a critical role in influencing the direction of load transmission, which subsequently affects the local biomechanical conditions. However, whether the improved restoration of sagittal alignment can biomechanically lower the incidence of AVF remains to be determined. This paper aimed to investigate the influence of kyphotic deformity on AVF and its corresponding biomechanical mechanism.

Methods: Clinical data of PKP-treated patients with OVCF were retrospectively reviewed in this study. The current patient cohort was divided into two groups based on the clinical outcomes observed during the follow-up period (with and without AVF). Kyphotic angles were measured from the preoperative and postoperative lateral radiographs of these patients, and the variations between these values were calculated to denote the kyphotic restoration value. Significant differences in these parameters were analyzed between patients with and without AVF. Moreover, the biomechanical influences of segmental kyphotic angles on adjacent segment stress values were determined using a well-validated numerical model to explain the biomechanical mechanisms underlying clinically observed phenomena.

Results: Clinical data of 121 PKP-treated patients with OVCF were enrolled in this study. The preoperative kyphotic angles between the two groups were comparable (12.83 ± 5.98, 12.93 ± 6.66, p = 0.942). By contrast, compared with patients with AVF, patients without AVF suffered significantly lower postoperative kyphotic angle values (10.11 ± 4.84, 7.85 ± 5.24, p = 0.044). Correspondingly, the kyphotic restoration was significantly better in patients without AVF (2.72 ± 2.26, 5.08 ± 4.2, p = 0.055). In addition, stress concentration is more evident in the model with severe fracture segmental kyphosis.

Conclusions: The clinical review and biomechanical simulations revealed that a greater degree of kyphotic correction during PKP procedures, along with a decreased postoperative kyphotic deformity, may help lower the incidence of AVF by easing stress concentration in the neighboring vertebral bodies. This topic deserves further validation through future prospective studies.

Objective: The treatment of tuberculosis at the craniovertebral junction (CVJ) remains challenging, with significant debate surrounding therapeutic approaches. Halo vest (HV) therapy provides a non-invasive immobilization alternative, while occipitocervical fusion (OCF) offers a surgical option. However, limited evidence exists comparing the efficacy of HV therapy with OCF for CVJ tuberculosis. This study aimed to evaluate the clinical outcomes and safety of HV immobilization in treating CVJ tuberculosis, compared with OCF.

Methods: This retrospective cohort study was conducted from January 2012 to December 2022 and included 43 patients diagnosed with CVJ tuberculosis. Radiographic and treatment data were meticulously analyzed to compare outcomes between patients treated with HV immobilization (Group H, n = 22) and those undergoing OCF (Group O, n = 21). Interventions comprised at least 28 weeks of HV immobilization for Group H and OCF supplemented with postoperative external fixation for Group O. Outcomes were evaluated using the Visual Analog Scale (VAS-neck), erythrocyte sedimentation rate (ESR), and radiographic stability (assessed via X-ray and CT). Statistical analyses included the Student's t-test (parametric data), Mann–Whitney U test (nonparametric data), and chi-square test (categorical variables), with a significance level set at p < 0.05.

Results: Over a 24-month follow-up, all patients exhibited successful healing of tuberculosis lesions. Group H demonstrated greater improvements in cervical flexion-extension and rotation function compared with Group O. Both groups showed statistically significant decreases in Visual Analog Scale (VAS-neck) and Neck Disability Index (NDI) scores, as well as in ESR and C-reactive protein (CRP) values from pre-surgery levels (p < 0.01). Notably, differences in VAS-neck (1 month) and NDI (24 months) between the groups were statistically significant (p < 0.05), while no significant differences were observed in other follow-up periods (p > 0.05). Additionally, there were no significant differences in ESR and CRP values at any time point between the treatment groups (p > 0.05).

Conclusions: The study yielded satisfactory outcomes for all patients. Short-term differences in pain relief did not significantly impact the healing of CVJ tuberculosis. Patients receiving HV treatment showed greater improvement in neck function compared with those undergoing occipitocervical fusion. Given the substantial costs and risks associated with open surgery, we advocate for conservative treatment utilizing HV.

Objective: Studies evaluating the long-term outcomes of the nano-hydroxyapatite/polyamide 66 cages (n-HA/PA66) in treating lower cervical spine fractures have not been reported. The objective is to compare the long-term clinical and radiographic outcomes of titanium mesh cage (TMC) and-HA/PA66 for anterior cervical corpectomy and fusion (ACCF) in the treatment of lower cervical spine fractures and dislocations.

Method: This retrospective analysis included 223 patients treated at our hospital between January 2010 and January 2016 who had undergone single-level anterior corpectomy for lower cervical spine fractures and dislocations (with a minimum follow-up of 8 years) using either a TMC (n = 130) or an n-HA/PA66 cage (n = 93). The radiographic parameters, including segmental alignment (SA), cage subsidence, plate-to-disc distance, cervical lordosis (CL), intervertebral height, and fusion status, along with clinical metrics such as Japanese Orthopedic Association (JOA) scores and visual analog scale (VAS) assessments, were systematically analyzed at preoperative, postoperative, and final follow-up intervals for the patients involved in the study. The Chi-Square (χ²) test for categorical variables and the Student's t-test for numerical data were used to assess differences between the two groups.

Result: The mean follow-up durations for the TMC group and n-HA/PA66 group were9.81 ± 2.21 and 9.43 ± 0.92 years, respectively. Moreover, final fusion rates were not significantly different between the n-HA/PA66 group and the TMC group (97.8% and 96.9%, respectively). The final cage subsidence was significantly lower in the n-HA/PA66 group (1.56 ± 0.88 mm, with 17.6% subsidence of > 3 mm) than in the TMC group (2.70 ± 2.02 mm, with 36.9% subsidence) (p < 0.01). Furthermore, CL, SA, plate-to-disc distance, JOA scores, and VAS scores were not significantly different between the two groups (all p > 0.05).

Conclusion: Within 8 years following single level ACCF surgery, the n-HA/PA66 cage may be better than TMC in anterior cervical construction for treating lower cervical fractures and dislocations.

Objective: Despite the widespread use of posterior lumbar interbody fusion (PLIF) for L5-S1 isthmic spondylolisthesis (IS) with lumbar spinal stenosis (LSS), residual sagittal imbalance critically impairs long-term pain relief and functional recovery. This study analyzes the influence of residual sagittal imbalanceon health-related quality of life (HRQOL) after PLIF for L5-S1 IS with LSS, aiming to optimize surgical correction and prognostic accuracy.

Methods: This study analyzed 103 consecutive patients with L5-S1 IS and LSS undergoing PLIF from 2020 to 2022, followed at 3 days, 3 months, and ≥ 1 year postoperatively, using SPSS 26.0 for statistical analysis. Preoperatively, patients were stratified into balanced (SVA ≤ 50 mm) and unbalanced (SVA > 50 mm) groups. Postoperatively, the unbalanced group was reclassified into postoperative balanced (SVA ≤ 50 mm) and postoperative unbalanced (SVA > 50 mm) groups. Spinal parameters—including SVA, slip degree (SD), disc height (HOD), lumbar lordosis (LL), pelvic tilt (PT), and pelvic incidence (PI)—and clinical outcomes (Oswestry Disability Index [ODI], Visual Analogue Scale [VAS]) were analyzed preoperatively and postoperatively to assess surgical efficacy. Postoperative unbalanced group.

Results: In the balanced and unbalanced groups, SD and HOD significantly improved postoperatively versus preoperative values (p < 0.05). The balanced group showed no postoperative changes in SVA, LL, or PT (p > 0.05), while the unbalanced group exhibited marked improvements in these parameters (p < 0.05). At final follow-up, the balanced group maintained superior SVA, SD, HOD, LL, and PT compared to the unbalanced group (p < 0.05). Among the unbalanced group, postoperative balanced and unbalanced groups demonstrated significant improvements in SVA, SD, HOD, and PT (p < 0.05). However, LL remained unchanged in the postoperative unbalanced group (p > 0.05), whereas it improved in the postoperative balanced group (p < 0.05). The postoperative balanced group also achieved better SVA, SD, HOD, LL, and PT outcomes versus the postoperative unbalanced group (p < 0.05). ODI and VAS scores improved across all groups postoperatively, with the balanced group and postoperative balanced group outperforming their counterparts at final follow-up (p < 0.05).

Conclusion: Preoperative and postoperative sagittal balance are pivotal determinants of long-term functional recovery and HRQOL in patients undergoing PLIF for L5-S1 IS with LSS.

Objectives: The combined anteversion technique was introduced to guide prosthesis orientation in patients with developmental dysplasia of the hip and has achieved favorable short-term results in a previously published series. However, excessive variations in implant orientation may increase the risk of accelerated polyethylene wear and lead to revision THA. This study aimed to report whether the variation in implant orientation caused by the combined anteversion technique would result in an increased surgical failure rate and the mid- to long-term clinical outcome in total hip arthroplasty for patients with hip dysplasia.

Materials and Methods: This retrospective study reviewed patients with hip dysplasia who underwent total hip arthroplasty with the combined anteversion technique between 2007 and 2012 at our center. The surgical protocol prioritized the combined anteversion principle, requiring maintenance of the combined anteversion within the 25°–50° range while permitting physiological variation in individual femoral or acetabular component positioning. In total, 55 patients (80 hips) were included, with an average follow-up period of 12.7 years (range, 11 to 16). Ceramic fragmentation, periprosthetic radiolucencies, and osteolysis around the cup and stem were evaluated based on the immediate postoperative pelvic anteroposterior radiographs and the last follow-up. Femoral, acetabular, and combined anteversions pre-and postoperatively were measured using CT-based models. The Harris hip score at the latest follow-up was used for comparison with the score before surgery.

Results: The average Harris hip score increased from 28.3 ± 10.1 preoperatively to 91.2 ± 6.7 (p < 0.01) at the last follow-up. The mean femoral, acetabular, and combined anteversions were 25.6° ± 11.1° and 23.7° ± 10.6°, 23.2° ± 7.4° and 19.8° ± 8.3°, and 48.7° ± 12.9° and 43.1° ± 6.8° preoperatively and postoperatively, respectively. By the last follow-up, one patient developed periprosthetic osteolysis 11 years after primary surgery without obvious periprosthetic loosening and migration of the femoral head rotation center. Two patients experienced prosthesis dislocation, one of whom received a revision 4 years after primary surgery, and the other underwent manual reduction under anesthesia 8 years after primary surgery. Two patients underwent revision and internal fixation due to prosthesis loosening caused by a periprosthetic fracture 10 years and 12 years after primary surgery.

Conclusion: The combined anteversion technique in total hip arthroplasty for patients with hip dysplasia yielded reliable mid-to-long-term results. This technique's changes in prosthesis angle did not significantly increase the surgical failure rate.

Objective: Abnormal pelvic coronal plane obliquity is a potential risk factor for cup instability during total hip arthroplasty. This study investigates the clinical function, acetabular cup position, leg length discrepancy, and improvement of obliquity in patients with infrapelvic obliquity after treatment with total hip arthroplasty in the direct anterior approach (DAA-THA).

Methods: A total of 987 patients who underwent DAA-THA in the supine position from January 2017 to January 2021 were retrospectively analyzed, and 158 of them were included. The infrapelvic obliquity was classified into two types according to the direction of obliquity. Type I is when the pelvis tilts to the side of the affected lower limb, while type II is pelvic obliquity on the side of the healthy lower limb. Cases were further classified into two subtypes according to the angle of pelvic obliquity obtained: 0°–3° for type A; ≥ 3° for type B. Clinical observation and follow-up were carried out at 1 day, 1 month, 3 months, 6 months, 1 year, and the last clinic visit (average 29 months). Standing hip radiographs were taken to measure the cup position, leg length discrepancy (LLD) and pelvic obliquity. The Harris score was used to evaluate hip function before and after surgery. Repeated measure ANOVAs were applied to compare multiple time points within groups, while the Fisher's LSD test was used for pairwise comparisons between the means of multiple samples across groups.

Results: As the degree of pelvic obliquity increased for each subtype, the pre-operative Harris score decreased and pre-operative LLD increased. The parameters of cup position remained stable over time for each subtype. After DAA-THA, the Harris score improved significantly and the degree of pelvic obliquity and LLD improved for each subtype (p < 0.001). Although the last follow-up showed the lowest Harris score and the poorest recovery of pelvic tilt and LLD, type IB patients demonstrated the greater improvement compared to the other types.

Conclusions: DAA-THA in supine position not only significantly improves the hip function of patients with infrapelvic obliquity, but also corrects pelvic obliquity and leg length discrepancy, while maintaining stable acetabular components. For patients with infrapelvic obliquity, in which the pelvis is oblique on the affected side and the angle is more than 3°, the degree of functional improvement and correction is the greatest.

Objective: Developmental dysplasia of the hip (DDH) exhibits abnormalities in hip anatomy, so changes in the acetabular and femoral angles hold clinical relevance. This study aimed to investigate the correlations between acetabular anteversion (AAV) and acetabular abduction (AAB), as well as between combined anteversion and combined abduction in patients with DDH, attempting to give evidence for synchronous torsion of the proximal femur and acetabulum. This study also aimed to propose a new method for predicting acetabular anteversion and combined anteversion angles, respectively, based on acetabular abduction and combined abduction angles on conventional pelvic radiographs.

Methods: This retrospective study included 202 patients (404 hips) with DDH who underwent THA at our institution from February 2013 to September 2021. Preoperative AAB/femoral neck-shaft angle (FNA) was recorded via radiograph. AAV/femoral anteversion (FA) was recorded via computed tomography and radiography. To assess the correlations between the AAV and AAB and between combined anteversion (sum of AAV and FA) and combined abduction (sum of AAB and FNA), linear regressions and Pearson's coefficients were calculated.

Results: All hips were categorized into five DDH subgroups according to the Crowe classification: 93 normal, 140 Crowe type I, 68 Crowe type II, 59 Crowe type III, and 44 Crowe type IV. Fairly positive correlations were observed between combined anteversion and combined abduction in normal (r = 0.509), type I (r = 0.637), type II (r = 0.423), and type III (r = 0.511) subgroups. AAV and AAB demonstrated a moderate positive correlation in the normal (r = 0.508), type I (r = 0.511), type II (r = 0.516), type III (r = 0.332), and type IV (r = 0.603) subgroups.

Conclusions: The AAV and AAB, as well as combined anteversion and combined abduction, exhibited positive correlations in normal and Crowe type I–III hips, suggesting the torsion of the acetabulum and synchronous torsion of the acetabulum and proximal femur. These findings quantify synchronized twisting of the hip and offer the potential significant implications for the accuracy of preoperative planning in THA, especially in DDH patients.

Background and Objective: Customized implants could improve the capture of fracture fragments for strengthened stability of tibial plateau fractures (TPFs) fixation. This study aimed to validate the feasibility of customized implants through optimized manufacturing within a clinically acceptable timeframe and evaluate the mechanical strength of customized internal implants through finite element analysis.

Methods: A retrospective was conducted. From May 1, 2023, to June 1, 2023, 10 patients with TPFs were treated at our hospital using various new internal fixation systems combined with customized technology. The indicators of patients characteristics, operation, and follow-up were collected, such as the cause of trauma, fresh or old, fracture classification, blood loss, Lysholm score, EQ-5D-3L score, and so on. Additionally, we created a Schatzker IV TPF model with two separated fragments in the medial to compare the biomechanical strength and directional deformation between standard medial dual plates (MDPs) and medial customized plate (MCP).

Results: The study found that the entire process of implant fabrication can be completed within a clinically acceptable timeframe of 3–4 days. We designed specific types of plates for different types of fractures, such as semi-circumferential plates for lateral TPFs, γ-type plates for medial TPFs, and pistol-type and wing-type plates for posterior TPFs. Follow-up analysis showed operative times of 1.37 ± 0.58 h, intraoperative blood loss of 260 ± 179.20 mL, and favorable functional outcomes: Lysholm score 88.6 ± 4.93, knee ROM 103.5° ± 11.56°, and EQ-5D-3L score 0.87 ± 0.47. Additionally, the γ-type plate showed comparable strength to the MDPs system via finite element analysis and demonstrated a more vital ability to resist the separation of fracture fragments, with the maximum displacement of MDPs (0.61878 mm) 2.4 times higher than that of MCP (0.26124 mm).

Conclusions: Using customized internal fixation systems provided solutions to challenges of complex fractures, within a clinically acceptable timeframe of 3–4 days. Notably, the study showed that the strength of customized internal fixation systems of γ-shaped plate was comparable to that of conventional implants. This innovative approach offered a new avenue for managing TPFs and even complex limb fractures.

Objective: Existing 3D classification systems for scoliosis primarily guide surgical treatment, with limited application in conservative management. This study aims to establish a preliminary 3D classification system for moderate adolescent idiopathic scoliosis patients in China, providing a theoretical foundation for the standardization and automation of conservative treatment plans.

Methods: Data from 404 adolescent idiopathic scoliosis patients who did not undergo surgery were retrospectively collected from 2022 to 2025. EOS imaging technology was used to perform 3D reconstruction for each patient. The parameters included the 3D centroid coordinates of the vertebrae and vertebral angular displacement. A total of 102 features were extracted per model, and dimensionality reduction yielded 30 final features by the Stacked Autoencoder method. Fuzzy C-means clustering with two classification approaches is used: direct clustering and iterative clustering. Iterative clustering was performed based on coronal plane parameters for initial classification, followed by further clustering. Direct classification involved immediate clustering without further subdivision.

Results: Clustering identified 8 distinct 2D curve types, which were further subdivided into 13 3D subtypes. A comparison of the 13 clusters from direct classification with those obtained from iterative clustering was made using Euclidean and Mahalanobis distances between cluster centers and clinical data. The difference in similarity was higher for direct classification, indicating greater variability.

Conclusion: EOS imaging technology combined with Fuzzy C-Means iterative clustering enables a preliminary 3D classification of AIS by capturing more detailed and individualized morphological features. Compared to direct clustering, the iterative method not only improves geometric interpretability but also enhances classification accuracy by better identifying subtle variations in spinal curvature. It further improves specificity, particularly in distinguishing sagittal and axial plane deformities, which are often overlooked in 2D systems. This enhanced resolution provides a stronger basis for developing personalized conservative treatment plans, such as brace design and rehabilitation strategy. Although the proposed method shows promise, further clinical validation is needed to confirm its effectiveness in guiding conservative treatment decisions.

Objective: Hemophilic arthritis is a progressive joint disease often requiring surgical intervention in advanced stages. However, comparative evidence on perioperative inflammatory and coagulation responses between single joint replacement (SJR) and multiple joint replacement (MJR) remains scarce. This study aimed to assess the differences in perioperative outcomes, including inflammatory responses, blood transfusion requirements, and functional recovery, to guide surgical decision-making for hemophilic arthritis patients.

Methods: This retrospective study included 29 male patients with moderate-to-severe hemophilic arthritis who underwent SJR (n = 12) or MJR (n = 17) at a single institution from October 2020 to October 2023. Data on inflammatory markers (CRP, ESR, IL-6, WBC), hemoglobin levels, blood transfusion requirements, and joint mobility were collected for the immediate postoperative period (days 1–14). Trends in inflammatory markers were analyzed using average percent changes (APC), and differences in outcomes were evaluated using the Mann–Whitney U test for continuous variables and Fisher's exact test for categorical variables. Longitudinal changes were analyzed using mixed-model repeated measures ANOVA with time points as fixed effects and subjects as random effects. Statistical significance was set at p < 0.05.

Results: Postoperative CRP levels declined significantly in both groups, with APCs of −9.06% (95% CI: −15.63 to −1.98, p < 0.05) for the SJR group and −8.42% (95% CI: −16.18 to 0.06) for the MJR group. ESR showed a significant upward trend, with APCs of 10.82% (95% CI: 0.95–21.65, p < 0.05) in the SJR group and 17.54% (95% CI: 11.71–23.67, p < 0.05) in the MJR group. Blood transfusion requirements were comparable, with median transfusion volumes of 0.00 units (IQR: 3.50) for SJR and 0.00 units (IQR: 3.75) for MJR (p = 0.761). Notably, joint mobility scores were significantly better in the MJR group (mean: 31.88, SD: 19.31) compared to the SJR group (mean: 18.33, SD: 10.39; p = 0.030). Despite the larger surgical scope of MJR, no significant differences in infection or bleeding risks (SJR:median transfusion = 0.00 units, IQR: 3.50; MJR:median transfusion, 0.00 units, IQR: 3.75. p = 0.761) were observed between the groups.

Conclusion: This study demonstrates that MJR offers superior functional recovery compared to SJR, without increasing the risks of infection, bleeding, or transfusion. These findings support MJR as a safe and effective surgical option for hemophilic arthritis patients when appropriate perioperative management protocols are implemented. Future studies with larger sample sizes and long-term follow-up are needed to validate these results and explore extended outcomes.

Objective: Approximately 80% of acetabular fractures involve the posterior wall and posterior column, which are complex and challenging to treat. The H-shaped anatomical titanium plate (HTP) facilitates anatomical reduction, minimizes complications, and enhances safety, efficacy, and speed. This study aims to conduct biomechanical testing and clinical evaluation of HTP to assess its stability and efficacy in treating these fractures.

Methods: In the biomechanical research, posterior column with posterior wall fractures was created on nine acetabular models procured from Sawbones, USA and were allocated to three fixation groups: (1) a single reconstruction plate combined with a single cortical screw (PCS), (2) double parallel reconstruction plates (2P), (3) HTP. Following anatomic reduction, cyclic loading and destructive experiments were conducted to assess the efficacy of different fixation devices under various loads for the posterior wall and column, as well as their peak load and structural stiffness. Additionally, we retrospectively analyzed the clinical data of 53 patients (46 males, 7 females; mean follow-up 24.6 ± 3.2 months) with the HTP at our hospital from April 2017 to January 2023. Clinical outcomes mainly included changes in postoperative pain, reduction quality (Matta criteria), hip function (Merle d'Aubigné Postel/Harris scores), and the incidence of complications.

Results: Biomechanical results showed that in cyclic loading tests, the relative displacement of the posterior wall and the posterior column fixed with the HTP was smallest, with statistically significant differences (p < 0.05). In the destructive experiment, compared to the 2P group (2062.89 ± 375.45 N, 412.16 ± 25.87 N/mm) and the PCS group (1477.89 ± 161.57 N, 204.21 ± 34.94 N/mm), the HTP group (3342.67 ± 354.15 N, 652.52 ± 24.25 N/mm) demonstrated superior peak load and structural stiffness, with statistically significant differences (p < 0.05). Clinically, Postoperative Visual Analogue Scale scores significantly decreased, indicating effective pain management. 84.91% achieved anatomic reduction, with 92.45% and 90.56% good/excellent functional outcomes (Merle d'Aubigné Postel and Harris scores, respectively). The incidence of various complications was low, with no cases of implant failure observed.

Conclusions: The HTP demonstrates robust stability in biomechanical experiments, offering distinct advantages for clinical applications and widespread adoption. In the treatment of the posterior column/posterior wall fractures, the integrated fixation of HTP aligns with the physiological anatomy of the acetabulum and has the advantages of simple operation, short operation time, strong stability, minimal risk of vascular and nerve injury, and fewer complications.

Objective: Subaxial cervical fracture-dislocation with bilateral locked facet joints represents a critical spinal injury. The management of this condition remains a subject of debate, particularly regarding the optimal surgical approach. This study aims to introduce a quantified indicator to guide surgical decision-making and to assess its safety in clinical practice.

Methods: We retrospectively compared 62 patients treated according to the Spinal Cord Buffer Space (SCBS) criteria with 63 patients treated before SCBS was introduced. Briefly, SCBS was measured on preoperative MRI to quantitatively assess whether sufficient buffer space exists for the spinal cord, ensuring that a posterior reduction can be performed without causing iatrogenic spinal cord injury. The neural status was assessed with the American Spinal Injury Association (ASIA) impairment scale. Local sagittal alignment was evaluated at the dislocation level. Fisher's exact test and independent t-test were used to compare the parameters between the two groups.

Results: Surgical planning according to SCBS is relatively safe, with no patient experiencing neurologic deterioration after operation (p = 0.014). Forty-two patients with preoperative grade E on ASIA had no postoperative changes. Thirteen patients with preoperative grade D recovered to grade E after surgery, while 7 patients remained grade D but reported improved limb function. In comparison, 63 patients were treated before SCBS was introduced. Among 47 patients with preoperative grade E, 43 patients remained grade E while 4 patients were downgraded to grade D. For 16 patients with preoperative grade D, there were 2 patients with postoperative grade C, 6 patients with postoperative grade D, and 8 patients with postoperative grade E. No loosening, displacement, or breakage of the implants was observed in both groups during the follow-up.

Conclusions: SCBS is a reliable and quantified indicator for surgical planning, and can significantly reduce the incidence rate of iatrogenic neurologic deterioration. For patients with a positive SCBS, posterior reduction can be safely performed. In contrast, for patients with a negative SCBS, anterior decompression should be prioritized.

Objective: The current classification of intertrochanteric femoral fractures primarily follows the AO/OTA system, which guides treatment but fails to accurately predict preoperative reduction difficulty. Since reduction quality directly impacts fracture healing, internal fixation success, and patient rehabilitation, developing a classification standard that aids in predicting reduction difficulty holds significant clinical implications for achieving optimal outcomes. The purpose of this study was to develop classification criteria for femoral intertrochanteric fractures based on their reducibility and irreducibility and to provide a reference standard for preoperative predictions of the level of difficulty likely to accompany the fracture.

Methods: Four hundred thirty-seven patients with intertrochanteric fractures of the femur treated at the Affiliated Hospital of Jining Medical University and several county hospitals from January 2015 to August 2023 were reviewed. The fractures were divided into irreducible and reducible types according to actual intraoperative reduction. The imaging data were collated and analyzed, the type of fracture that may have affected the reduction was selected, the data were collated according to the type of fracture as well as the AO type, unconditional univariate logistic regression analysis was performed, and the OR values were calculated.

Results: Logistic regression revealed that the risk factors leading to irreducibility were 31A3, 31A3.3, 31A1 (with obvious separation displacement), 31A2 (with anterior angular exostosis) and 31A2 (with a concomitant proximal femur fracture) fractures. Intertrochanteric fractures were typed according to the risk factors suggested by the statistical results and the specific intraoperative imaging manifestations, with irreducibility divided into 3 types and reducibility divided into 2 types, each with their respective subtypes. The accuracy of this typing in predicting the degree of difficulty of intraoperative restoration was 78.4% (343/437), and the test of consistency showed kappa = 0.573 (moderate consistency).

Conclusion: Classifying intertrochanteric fractures into reducible and irreducible types can accurately preoperatively predict the difficulty of reduction for the vast majority of reducible fractures and most irreducible fractures, guide treatment, and predict the prognosis of the fracture.

Objective: Osteoarthritis (OA), a high-prevalence degenerative cartilage disease, urgently requires novel therapeutic strategies. M2 macrophage-derived exosomes (M2-Exo) demonstrate therapeutic potential for OA, though their regulatory mechanisms in chondrocyte-macrophage (Mφ) interactions remain to be elucidated. To investigate the regulatory effects of M2-Exo on chondrocytes and Mφ in vitro, and to evaluate the therapeutic effect of the M2-Exo-loaded hydrogel system (ALG-M2Exo) on cartilage damage in a rat OA model.

Methods: In the cell experiment, M2-Exo were extracted and characterized using ultracentrifugation. Different concentrations of M2-Exo were co-cultured with inflammatory chondrocytes or M1Mφ to evaluate their direct anti-inflammatory effects and the ability to promote M1Mφ repolarization to the M2 phenotype, using methods such as EdU, TUNEL, qRT-PCR, and Western blot. Then, the repolarized RM2Mφ were co-cultured with inflammatory chondrocytes to verify their anti-inflammatory efficacy, employing similar detection methods. In the in vivo experiment, sodium iodoacetate was injected to establish a rat knee OA model, followed by interventions including ALG-M2Exo. After 4 and 8 weeks, samples were collected for gross observation and histological staining to assess cartilage damage repair.

Results: In the cell experiment, M2-Exo exhibited typical exosomal characteristics, directly promoting the proliferation of inflammatory chondrocytes, inhibiting their apoptosis, reducing the expression of TNF-α, iNOS, and MMP-13, and increasing the expression of IL-10 and COL II. RM2Mφ showed similar therapeutic effects on inflammatory chondrocytes as M2-Exo. In the in vivo experiment, the ALG-M2Exo group demonstrated superior repair effects on cartilage damage compared to other groups, with the treatment effect at 8 weeks being better than at 4 weeks.

Conclusion: ALG-M2Exo effectively promotes the repair of cartilage damage in OA through both a direct pathway by releasing M2-Exo that act on chondrocytes and an indirect pathway that facilitates the repolarization of M1Mφ to M2Mφ.

Objective: Multiple reconstruction approaches for the anterior sternoclavicular joint have been described. No gold standard technique has been established. Owing to the well-established role of open reduction and internal fixation by means of plates and/or screws, rigid fixation is associated with the risk of implant failure, migration, and need for removal. This study aimed to evaluate the safety and efficacy of using button plates for the treatment of anterior sternoclavicular joint dislocation.

Methods: From January 2018 to May 2021, seven patients with a median age of 47 (range 37–57) years were treated for traumatic anterior sternoclavicular joint dislocations. The American Shoulder and Elbow Surgeons score (ASES), the visual analog scale (VAS) for pain and abduction, and forward elevation of the shoulder were used to evaluate clinical outcomes before the index surgery, at the removal of the implant, and at the latest follow-up. The satisfaction of patients was measured with the standard of Marsh.

Results: Open surgical reduction and sternoclavicular joint repair were successfully achieved in all the patients. They were also followed up, for a mean duration of 16.14 months. The mean postoperative abduction angle of the glenohumeral joint was 165.43 (range, 149°–173°), and the angle of one glenohumeral joint was less than 160 (149). The mean posterior extension angle of the glenohumeral joint was 26° (range, 24°–30°). The mean forward flexion was 161.25° (range, 150°–168°), and the horizontal extension was 39.57° (range, 35°–45°), respectively. According to the ASES scoring system, the mean postoperative physical function was 89.58, which was an improvement from the mean preoperative function, which was 25.48. There were no complications, wound infections, blood vessel or nerve injuries, or fixation failure. The patient satisfaction rate was 100%.

Conclusion: Button plate fixation technique is safe, simple, and effective and has been successfully used in treating sternoclavicular joint dislocation, with excellent functional outcome.

Background: Spondylocostal dysplasia (SCD) is characterized by vertebral defects and rib abnormalities. Following radiological diagnosis, further genetic testing is conducted to confirm the mutant loci and identify the subtype of SCD. While seven loci potentially associated with SCD have been identified, rare cases remain unexplained.

Case Presentations: A 37-year-old female diagnosed with SCD at birth was reported in this study. She exhibited scoliosis and thoracic asymmetry, along with a left-sided bilateral breast deformity. Imaging analysis revealed congenital scoliosis with a lack of segmentation, deformity of multiple ribs, and a lower spinal cord. Using whole-exome sequencing, we identified the genetic variant in the afflicted individual. We detected a heterozygous exon 16 FLNA variant in the afflicted individual and confirmed the absence of pathogenic variants of other known SCD-associated genes.

Conclusions: The variant NM_001456.4: c.2351T>C detected in this study enhances our knowledge of the pleiotropy linked with heterozygous FLNA variants. By expanding the mutation spectrum of FLNA, these findings will lay a foundation for further studies on the correlation between genotypes and phenotypes.