Objective: Iliopsoas impingement (IPI) syndrome is a significant complication following total hip arthroplasty (THA), often leading to pain and reduced hip function. Despite its clinical relevance, the optimal treatment strategy remains unclear, with varying success rates reported across different interventions. This study aims to compare four treatment options (endoscopic, acetabular cup revision, open tenotomy and conservative management) for patients with IPI syndrome after THA by comparing outcomes in terms of function, pain, complications, and reoperations through a multilevel meta-analysis.

Methods: A literature search was conducted in the following databases until 30 November 2024: PubMed, CENTRAL, Epistemonikos, and Embase. A frequentist multilevel meta-analysis was performed using a random effects model with an inverse variance and restricted maximum likelihood heterogeneity estimator with Hartung-Knapp adjustment. Means with 95% confidence intervals (CIs) were calculated separately in the four treatment groups. Then, a test for subgroup differences in multilevel meta-analysis was performed to determine whether there is a statistically significant difference between the means of the four groups.

Results: The systematic review included 15 studies with 425 patients. The test for subgroup differences showed no statistically significant difference between the four treatment subgroups in Harris Hip Score (HHS) post-intervention (F = 2.0; df = 3, 7; p = 0.20), in HHS difference (F = 2.0; df = 3, 6; p = 0.22), and in functional minimal clinically important differences (MCID) post-intervention (F = 1.0; df = 3, 2; p = 0.42). The conservative management group exhibited the lowest mean HHS (70.3 points).

Conclusions: Surgical interventions, including endoscopic tenotomy, acetabular cup revision, and open tenotomy, are effective in achieving meaningful functional improvements in IPI patients. While conservative management was the least effective of all treatment groups, the differences did not reach statistical significance.

Osteoarthritis (OA) is a common musculoskeletal disorder impacting millions in the United States, presenting with joint pain, stiffness, and reduced mobility. Its complex origins and lack of clear early-stage symptoms make early detection challenging. Traditional diagnostic methods, including imaging, are often used when significant cartilage loss has already occurred. However, serum biomarkers offer potential for earlier and less invasive detection. For our review, articles published from 1980 to 2024 that analyzed OA serum biomarkers were retrieved from PubMed, Embase, and Web of Science. The analysis included biomarker frequency, percent changes from baseline levels, and logistic regression to assess correlations with OA. Several biomarkers exhibited altered levels in OA, classified into inflammatory, collagenous, mechanical stress, and other categories. Inflammatory markers such as IL-6 and MPO showed significant elevation, while TNF-α showed minimal correlation with OA. Collagenous markers, especially COMP, were consistently elevated in patients, correlating with disease severity. Additionally, PIIANP showed a strong negative correlation with OA progression. Obesity-related markers, including resistin, were also associated with OA, and logistic regression confirmed IL-6, COMP, and resistin as strongly correlated with OA, with PIIANP demonstrating a significant inverse relationship. This review highlights the critical role of serum biomarkers in OA detection and progression. Markers like IL-6, COMP, and PIIANP offer significant potential for early diagnosis. Integrating these biomarkers into clinical practice may facilitate earlier intervention, potentially slowing OA progression. Future research should focus on validating these findings across larger, diverse populations and refining therapeutic strategies targeting these biomarker pathways.

The management of osteochondral lesions of the talus (OLT) remains a challenging clinical issue. With advances in theory and technology, treatment options for OLT have expanded significantly. This review examines recent progress in the clinical treatment of OLT, focusing on studies published from 2021 to 2023. We searched PubMed, Embase, and Cochrane databases to identify relevant clinical treatments, including both nonsurgical and surgical approaches. Surgical advancements have primarily centered on microfracture, bone transplantation, cartilage transplantation, combined cell therapy, and biomaterials. Among these, some innovative methods, such as autologous costal cartilage transplantation and biological scaffolds, have yielded promising clinical outcomes. However, high-quality clinical studies are still lacking, particularly those exploring nonsurgical treatments and physical therapy. Future research may increasingly focus on integrating biomaterials with physical therapy, which holds potential for improving patient outcomes.

Background: Total hip arthroplasty (THA) is a highly successful orthopedic procedure, with numerous meta-analyses published to optimize its outcomes. However, the reliability of their results and conclusions depends heavily on the use of appropriate statistical methods. Therefore, the aim was to test the reliability of statistical methods in meta-analyses of THA by examining the degree of heterogeneity, the effect of different between-study variance estimators, and the equality of sample size of pooled primary studies.

Methods: The literature was systematically searched in PubMed from January 1, 2022, to December 31, 2023, for meta-analyses on THA. The quality of the meta-analyses was assessed using the revised Measurement Tool to Assess Systematic Reviews (AMSTAR 2). All meta-analyses were recalculated using eight different heterogeneity estimators. The following indicators were considered: inequality of patient numbers, proportion of random-effects and fixed-effects models, heterogeneity with I² value, ratio of effect sizes (RES), ratio of confidence interval width (RCIW), and the number of significant results. Mixed linear regression was then used to analyze whether the effect sizes and CIW were significantly different using different heterogeneity estimators. Finally, all examined meta-analyses were recalculated using the eight heterogeneity estimators and the Hartung–Knapp (HK) adjustment.

Results: Of the 24 meta-analyses examined, 15 reported an outcome using a mean difference and 20 reported an outcome using an odds ratio. The quality assessment identified 10 meta-analyses of high quality, 7 of moderate quality, 4 of low quality, and 3 of critically low quality. The significance of the examined meta-analyses varied considerably depending on the heterogeneity estimators used. In particular, the DerSimonian and Laird and Hunter–Schmidt heterogeneity estimators tended to produce false-positive results. The meta-analyses examined generally did not use HK adjustment. This effect is amplified when combined with the weak DerSimonian and Laird heterogeneity estimator, which were used in almost all examined meta-analyses.

Conclusion: Without HK adjustment, the results depend strongly on the heterogeneity estimator chosen and there is a risk of false positives, especially for the widely used DerSimonian and Laird heterogeneity estimator. For HK adjustment, the choice of heterogeneity estimator seems to play a less important role. We recommend the use of more reliable heterogeneity estimators as well as the HK adjustment as a measure to improve the statistical methodology of meta-analyses. This study highlights the critical need for improved statistical rigor in meta-analyses of THA, ensuring more reliable evidence for clinical decision-making and guideline development.

Purpose: There are many causes of thoracic ossification of the ligamentum flavum (TOLF), of which mechanical stress factors have gained increasing attention. This study aimed to explore the potential pathogenesis of TOLF by comparing spinal sagittal alignment parameters between patients with TOLF and an asymptomatic population.

Methods: We retrospectively included patients who underwent surgical treatment for thoracic myelopathy caused by OLF at Peking University Third Hospital from 2012 to 2022. Sagittal alignment parameters measured by picture archiving and communication system were compared between the TOLF group and a control group with independent t-test, Wilcoxon rank-sum test, and Chi-Squared test. Patients with caudal insertion of OLF above the T10 level were categorized into Group 1, while those with caudal insertion below the T10 level were categorized into Group 2. Sagittal alignment parameters were then compared among these two groups and the control group.

Results: Compared with the control group, the OLF group exhibited less lumbar lordosis (44.46° ± 11.41° vs. 52.55° ± 9.70°, p < 0.001), greater thoracolumbar curvature, greater PI-LL mismatch, and greater SVA imbalance. In patients with caudal insertion of the OLF above the T10 level, PI, PT, and LL were smaller compared to the control group. Patients with caudal insertion below the T10 level had smaller LL, greater thoracolumbar kyphosis, more severe SVA imbalance, and more severe PI-LL mismatch.

Conclusion: Patients with TOLF have a straighter spine. Mechanical stress plays a more significant role in the development of TOLF in patients with caudal lesions below the T10 level. In patients with TOLF not involving the thoracolumbar segment, factors other than mechanical stress, such as endocrine factors, may play a more crucial role in the development of TOLF.

Objective: Patellofemoral osteoarthritis (PFOA) is a common condition that significantly affects quality of life. With advancements in modern patellofemoral arthroplasty (PFA) prostheses, a growing number of surgeons are opting for PFA to treat isolated PFOA. This meta-analysis aimed to compare the perioperative resource use and therapeutic outcomes of PFA versus total knee arthroplasty (TKA) in patients with isolated PFOA.

Methods: A literature search was conducted in PubMed, EMBASE, the Cochrane Library, and the Web of Science until November 2024. The included studies provided direct comparisons of perioperative resource use (surgical time, blood loss, and length of stay) and postoperative outcomes (patient-reported outcome measures [PROMs], quality of life, and patient satisfaction) between modern PFA and TKA in patients with isolated PFOA. The Cochrane risk of bias assessment tool was applied to randomized controlled trials, and the modified Newcastle-Ottawa Scale was used for observational studies to evaluate methodological quality and risk of bias. Data was extracted from eligible studies and combined to calculate the mean difference (MD) or pooled relative risk with a 95% confidence interval (CI).

Results: We included eight eligible studies with a mean follow-up duration of 2–10 years. Compared with TKA, modern PFA demonstrated significantly shorter surgical times (MD = −13.67 min; 95% CI: −20.47 to −6.86) and reduced perioperative blood loss. However, no significant difference was observed in hospital length of stay. Regarding PROMs, PFA showed superior functional outcomes on the Oxford Knee Score (OKS) within 2 years postoperatively (MD = −2.02; 95% CI: −3.77 to −0.26). No significant differences were found between PFA and TKA at 12-month follow-up for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score (MD = −5.68; 95% CI: −21.54 to 10.18) or total WOMAC score (MD = −6.65; 95% CI: −30.00 to 16.70). Similarly, at 24-month follow-up, no differences were observed in the University of California, Los Angeles activity score (MD = −0.02; 95% CI: −1.79 to 1.75) or final OKS (MD = −1.09; 95% CI: −6.31 to 4.14). Quality of life and patient satisfaction remained comparable between the two procedures throughout the first 2 years and final follow-up.

Conclusions: PFA demonstrates comparable efficacy to TKA in isolated PFOA, with superior early functional recovery within the first 2 years post-surgery, shorter surgical duration, and reduced blood loss. These findings suggest PFA may be a resource-efficient alternative for eligible patients.

Objective: Minimally invasive reduction and intramedullary nailing (IMN) are the most common strategies used to treat subtrochanteric femur fractures (SFF). We report a new minimally invasive surgical technique for the successful reduction of SFF and maintenance of fragmental position after longitudinal traction. This study compared the radiological and clinical effects of these two reduction techniques when using IMN to treat SFF.

Methods: All 43 patients who underwent SFF at our hospital were included in this retrospective study. Twenty-two patients were treated using the conservative method (CM) from March 2016 to January 2018. Between May 2019 and March 2022, 21 patients with SFF were treated using this new technique (NT). All the patients completed the entire follow-up period. Details of both groups were obtained and analyzed from electronic medical records. Postoperative complications, fracture reduction quality, and fracture healing times were recorded and compared.

Results: There were no statistically significant differences after comparing both groups in terms of patient demographics or the incidence of complications. The mean operating time was 68.2 min (range, 54–85 min) in the group NT, shorter than 78 min (range, 65–103 min) in the group CM (p = 0.005). Compared to 275.6 mL average blood loss using NT, that using CM was 329.5 mL (p = 0.021). Three patients (14.2%) experienced deep venous thrombosis of the affected lower limb; however, no other postoperative complications occurred in the NT group, similar to those in the CM group. Compared to the uninjured side, the average fracture displacement was corrected to 2.7 mm (range, 2–4 mm) in the anterior–posterior view, and the mean anterior angulation was restored to 2.0° (range, 0°–10°) in the lateral view in group NT. All fractures in the NT group achieved consolidation healing within a mean time of 4.7 months (range, 4–8 months). The lower-extremity functional scale (LEFS)score of all patients was 60.4 (range, 47–71) in the NT group at the last follow-up. Similar results were observed for fracture reduction quality, time to bone union, and the LEFS in the CM group.

Conclusions: The soft tissue rebalancing technique utilizes hemostatic forceps as a lever and soft tissue around the fracture end as fulcrums to successfully overcome deforming forces in the proximal femoral fragment. Compared to CM, it is a minimally invasive, time-saving method for closed reduction and maintenance of the fragment position before opening and reaming.

Objective: The management of infectious tibial defects with concomitant soft tissue loss (ITD-STL) continues to pose substantial clinical challenges in orthopedic practice. This study aimed to compare the clinical efficacy of the Taylor Spatial Frame (TSF) versus the Monolateral External Fixator (MEF) in achieving bone and soft tissue reconstruction for ITD-STL.

Methods: A retrospective cohort study was performed on 49 consecutive patients with ITD-STL admitted between July 2010 and September 2022. The dataset included 25 patients who received treatment with the TSF, whereas 24 patients underwent treatment with the MEF. Demographic information, wound healing time, bone healing index, external fixation index, cost of hospitalization, and complications were recorded and compared between the two groups. Bone healing and functional recovery were assessed at the last follow-up (mean 18.8 months postoperatively; range 12–24 months) using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) score. Then, statistical analysis such as independent samples t tests or chi-Square test was performed.

Results: The wound healing time was (89.5 ± 30.6 days) in the TSF group and (86.2 ± 31.8 days) in the MEF group (p > 0.05). The bone healing index was (45.49 ± 11.99 d/cm) in the TSF group and (48.20 ± 13.01 d/cm) in the MEF group (p > 0.05). The external fixation index of the TSF group (52.4 ± 7.2 d/cm) was significantly lower than the MEF group (58.6 ± 10.3 d/cm) (p < 0.05). The total hospitalization cost was significantly higher in the TSF group compared to the MEF group (67.16 ± 2.46 thousand RMB vs. 42.67 ± 2.35 thousand RMB; p < 0.05). The overall complication rate was significantly lower in the TSF group (56%) than in the MEF group (75%). At the final follow-up, no significant differences in the ASAMI scores were observed between the two groups (p > 0.05).

Conclusion: The use of TSF and MEF for ITD-STL can achieve bone reconstruction and soft tissue repair via bone transport, yielding a positive therapeutic effect. However, TSF treatment is a superior method, characterized by better biomechanical properties and fewer complications, particularly in the correction of postoperative tibial axial deviation. However, these benefits might be offset by the economic costs they could entail.

Objectives: Prosthetic joint infection (PJI) caused by Mycoplasma infection is relatively rare in clinical practice; all cases are primarily reported as individual case reports, and the characteristics of PJI induced by Mycoplasma infection have not been clearly studied. This case–control study was designed to systematically compare demographic profiles, clinical histories, diagnostic modalities, and therapeutic outcomes between Mycoplasma PJI and conventional bacterial PJI through retrospective analysis.

Methods: This retrospective single-center study included 6 cases of simplex Mycoplasma PJI, 4 cases of mixed Mycoplasma PJI, 33 cases of Staphylococcus aureus, and 21 cases of Staphylococcus epidermidis infection from January 1, 2017 to January 1, 2024. Perioperative inflammatory markers, pathogen cultures, metagenomic next-generation sequencing (mNGS) results, history of invasive urinary catheterization, clinical presentation, treatment, and rate of treatment success were recorded and analyzed for the four groups. Continuous variables were compared two-by-two between the four groups using independent t-tests or the Mann–Whitney U test based on the distribution of the data. The categorical variables were compared using the chi-square test or Fisher's exact test.

Results: The proportion of invasive urinary catheterization history in the mixed versus simplex Mycoplasma group was significantly higher than that in the Staphylococcus aureus and Staphylococcus epidermidis control groups (p < 0.05). Routine microbial culture positivity was significantly lower in the mixed versus simplex Mycoplasma group than in the control group (p < 0.01), but positive results for Mycoplasma can be detected by mNGS. Of note, one patient in the simplex Mycoplasma group was cured with targeted antibiotic-only therapy and avoided surgery. There was no statistically significant difference in cure rates between the mixed and simplex Mycoplasma groups and the Staphylococcus aureus and Staphylococcus epidermidis control groups (p = 1.000).

Conclusion: Prior invasive urinary catheterization represents a significant risk factor for Mycoplasma PJI. The synergistic use of mNGS, optimized culture methods, and 16S rRNA PCR enables early detection of Mycoplasma. This multimodal diagnostic approach significantly enhances pathogen identification accuracy, minimizes diagnostic oversights, and provides essential guidance for effective therapeutic intervention.

Objective: Congenital angular kyphosis with compressive myelopathy is a rare yet underreported neurologic emergency for spine surgeons. The study aimed to report the neurological outcomes of 39 patients with compressive myelopathy in congenital kyphosis (CK) and provide magnetic resonance imaging (MRI) features in these patients, identifying the potential prognostic factors.

Methods: This is a retrospective cohort study. From January 2010 to December 2022, 39 patients were diagnosed with severe congenital angular kyphosis with compressive myelopathy and received surgical correction. The American Spinal Injury Association (ASIA) Impairment Scale grades at admission and final follow-up were recorded to measure neurological outcomes. A series of qualitative and quantitative parameters were evaluated on preoperative MRI by observers who were blinded to the clinical outcomes. According to the final status of neurological recovery, patients were divided into two groups and compared: Group E (patients with ASIA E) and Group N (patients with ASIA A, B, C, and D).

Results: At the final follow-up, 79.5% of patients (31 cases) had improved neurological function and myelopathy symptoms. The average Cobb angle of kyphosis decreased from 78.4° to 20.1° after correction surgery. The duration of myelopathy in Group N was significantly longer than that in Group E (p = 0.038). T1-weighted imaging (T1WI) signal hypointensity was presented in 35.9% (14/39) of patients, and T2-weighted imaging (T2WI) signal hyperintensity was 69.2% (27/39). On average, these patients had a maximum canal compromise (MCC) of 52.2%, maximum spinal cord compression (MSCC) of 47.0%, and maximum transverse area compression (MTAC) of 49.1%. Compared to Group E, Group N showed greater MCC (p = 0.023), MSCC (p = 0.008), and MTAC (p < 0.001) at baseline, and was more likely to present T1WI hypointensity and T2WI hyperintensity. The cut-off values of MTAC, MCC, and MSCC for fully neurological recovery were 47.1%, 46.7%, and 52.6%, respectively.

Conclusion: MRI indicators of poor prognosis in CK patients with compressive myelopathy included the presence of T1WI hypointensity, T2WI hyperintensity, and greater MCC, MSCC, and MTAC. It was suggested that early surgical intervention is critical to prevent irreversible cord injury, particularly in patients with MTAC > 47.1%.

Objective: Patients with impaired glucose metabolism have an increased incidence of post-operative complications. The best marker for glycemic control prior to elective orthopedic surgery remains unclear. We aimed to assess the utility of the hemoglobin glycation index (HGI) in predicting early complications following elective orthopedic surgery.

Methods: We retrospectively enrolled 1496 patients who underwent elective orthopedic surgery at Fujian Provincial Hospital in China from Jan 2015 to Jan 2023. Restricted cubic spline (RCS) was used to select the cutoff value of HGI. Propensity score matching (PSM) was performed to reduce confounding bias, and multivariate logistic regression models (with and without adjustment) for complication outcomes were applied to evaluate the odds ratios of HGI.

Results: The U-shaped curve in RCS analysis suggested dividing HGI into three subgroups: the reference interval (−0.76 to −0.10), the lower group (≤ −0.76), and the higher group (> −0.10). The incidence of early complications significantly increased from the lower (12.5%) and higher (12.2%) subgroups to the reference interval (6.9%). Following PSM, total postoperative complications were more common in patients with lower HGI (OR: 3.272, 95% CI: 1.417–7.556), but patients in the higher HGI subgroup had a higher risk of incision complications (OR: 3.735, 95% CI: 1.295–10.769).

Conclusions: After adjusting for HbA1c levels, higher HGI (> −0.1) was a risk factor for incision complications, but not for other complications. The risk of overall postoperative complications in patients with lower HGIs (≤ −0.76) should not be ignored.

Objectives: B3GALT6-related disorders are characterized by severe early-onset spinal deformities requiring surgical corrections but are associated with increased risks of perioperative complications. This study reports the clinical experience and outcomes of selecting the substantially touched vertebra (STV) as the lowest instrumented vertebra (LIV) in spinal surgeries for patients with B3GALT6-related disorders, a group of extremely rare skeletal and connective tissue disorders.

Methods: This retrospective study included patients who were molecularly diagnosed with B3GALT6-related disorders and received spinal surgeries for (kypho)scoliosis between 2017 and June 2023. Their medical records were reviewed. We also conducted a systematic literature review to identify (kypho)scoliosis management in patients with B3GALT6-related disorders.

Results: We identified a total of four patients. Patient 1 presented with severe kyphoscoliosis and segmentation defects and received a pedicle subtraction osteotomy with short fusion and dual growing rods from T3 to L3. However, coronal imbalance was observed at the 18-month follow-up. Genetic testing revealed biallelic disease-causing variants in B3GALT6. A revision surgery was successfully performed, with the level of the LIV extended to the STV (L4). The LIV was similarly extended to the STV in the index surgery for subsequent Patients 2 and 3 who received preoperative genetic testing results, and no complication has been observed. Patient 4 underwent preoperative Halo-pelvic traction to minimize complications, followed by posterior spinal fusion. The curves were successfully reduced without complications. A systematic literature review identified 86 articles reporting (kypho) scoliosis management in 12 of the 63 patients with B3GALT6-related disorders. Limited surgical experience has been reported, with an increased rate of complications, including death.

Conclusions: Selecting the STV as the LIV is recommended in spinal surgeries for patients with B3GALT6-related disorders, considering the characteristic joint hypermobility associated with the condition. Additionally, preoperative Halo-pelvic traction may also be safe and effective. Furthermore, preoperative molecular diagnosis is essential for enabling precision medicine and minimizing complications.

Objective: Ankylosing spondylitis (AS) often presents with spinal kyphosis, and pedicle subtraction osteotomy (PSO) is a common surgical technique for correcting AS-related kyphosis. However, after PSO, the posterior column lacks rigid bone support, potentially leading to intervertebral disc mobility and loss of correction. This study aims to introduce a novel 3D-printed laminae for the treatment of AS-related kyphosis.

Methods: This is a retrospective cohort study. A total of 48 patients receiving posterior correction surgeries between December 2021 and January 2022 were included and divided into two groups according to whether they accepted the 3D-printed laminae. We propose a novel approach using 3D-printed laminae to enhance posterior column stability and reduce deformity loss. Sixteen patients receiving 3D-printed laminae and 32 patients who did not receive that device. We collected preoperative and postoperative radiographic parameters, perioperative data, and patient-reported clinical scores. Statistical analysis involved independent sample t tests or randomization tests for continuous variables and chi-square tests for categorical variables.

Results: In the implanted group, kyphosis was corrected from 75.88° preoperatively to 27.06° postoperatively, and in the unimplanted group, from 70.98° to 28.42°. At the last follow-up, the ΔGK (global kyphosis) was 1.76° in the implanted group and 2.50° in the unimplanted group. PJA was 9.77° in the implanted group and 15.45° in the unimplanted group, showing significant differences. Two patients in the unimplanted group experienced sagittal reconstruction failure. Health-related quality of life (HRQoL) scores improved in the implanted group, with back pain scores of 2.63 and Oswestry Disability Index (ODI) scores of 13.50.

Conclusions: Our study introduces a novel 3D-printed laminae technique for AS-related kyphosis, aiding in maintaining sagittal balance. Patients reported improved subjective outcomes, including reduced pain and better HRQoL.

Objective: Late-onset neurological deficit is a severe complication usually attributed to the medullary compression at the apex as the kyphotic deformity develops gradually. However, little is known about another rare cause of proximal adjacent segment degeneration (ASD) above the kyphosis. This study aimed to report the surgical outcome of rigid posttraumatic thoracolumbar kyphosis combined with neurological deficits and to illustrate the different causes of late-onset spinal cord dysfunction and their relationship to spinopelvic alignment.

Methods: In this retrospective cohort study, 39 patients with rigid posttraumatic thoracolumbar kyphosis who underwent surgical correction were enrolled. All patients had late-onset spinal cord dysfunction, and the causes were classified according to the location of the lesion. Patients were divided into Group A (patients without proximal ASD) and Group B (patients with proximal ASD). Neurologic status was graded using the American Spinal Injury Association (ASIA) Impairment Scale. The visual analog scale (VAS) and Japanese Orthopedic Association scores-29 (JOA-29) were utilized for clinical assessment. Radiographic parameters of X-ray and MRI were compared between the two groups.

Results: Twenty-three patients (59.0%) had neurological deficits only resulting from the kyphosis itself, and 10 patients (25.6%) had developed neurological dysfunction related to thoracic stenosis above the kyphosis. The remaining six patients (15.4%) had coexisting compression both at and above the kyphotic apex. All the ASD occurred in the lower thoracic spine, and the level of T10/11 was the most involved site. Patients who developed proximal ASD had significantly smaller adjacent thoracic kyphosis (ATK) (1.2 ± 9.6 vs. 14.4 ± 11.6, p < 0.001). These patients had significantly worse preoperative ASIA grades and lower JOA-29 at final follow-up.

Conclusions: Proximal ASD above kyphosis could cause late-onset neurological deterioration. Compensatory lordosis in the lower thoracic spine might be associated with degenerative spinal stenosis. The dominant compensatory mechanism might be a decisive factor in developing proximal ASD.

Objective: Hip fractures in elderly patients are a major public health concern, associated with high morbidity and mortality. Early identification of high-risk patients is crucial to guide clinical decision-making, optimize resource allocation, and improve outcomes. However, existing risk prediction models, such as the Nottingham Hip Fracture Score (NHFS) and the Charlson Comorbidity Index (CCI), require laboratory or postoperative data, delaying risk stratification. This study aims to develop and validate the FPG score, a novel and simplified tool for predicting intrahospital mortality in elderly patients undergoing surgery for proximal femur fractures, using only admission data available at triage.

Materials and Methods: This single-center, observational cohort study was conducted in two phases: a retrospective derivation phase (2015–2019) and a prospective validation phase (2020–2022). Patients aged ≥ 65 years with proximal femur fractures (AO 31A, 31B) undergoing surgical treatment were included. Exclusions involved pathological, periprosthetic, and femoral head fractures (31C). Data on demographics, comorbidities, vital signs, and laboratory values were collected at Emergency Unit triage. The primary outcome was intrahospital mortality. Univariate and multivariate logistic regression identified predictors, and ROC analysis assessed the FPG score's predictive performance, with AUC, sensitivity, and specificity evaluated using SPSS v25 and MedCalc v18.

Results: In the retrospective phase, 1984 patients (median age: 83.5 years, 28.7% male) were analyzed, with an observed intrahospital mortality of 3.8% (77 patients). The FPG score demonstrated an AUC of 0.79, outperforming NHFS and CCI. A score > 2 was associated with a > 50% mortality risk, with 61% sensitivity and 80% specificity. In the validation cohort (752 patients, 4.8% mortality), the FPG score maintained strong predictive performance (AUC = 0.751).

Conclusion: The FPG score provides a rapid, objective, and clinically applicable tool for mortality risk assessment in elderly patients with hip fractures, allowing for immediate triage-based decision-making. Unlike NHFS and CCI, it does not require laboratory or post-admission data, making it particularly useful in emergency settings. Its integration into clinical practice may enhance patient management, improve resource allocation, and facilitate early intervention. While the score has been validated in a single-center study, further multicenter validation is needed to confirm its broader applicability. Future research should explore the integration of frailty indices and laboratory markers to refine its predictive accuracy.

Objective: Studies have described the nonuniform settlement of C2 lateral mass (C2LM-NUS) as an asymmetrical change of the bilateral C2 lateral masses. This study aimed to: (1) identify the objective evidence for the C2LM-NUS and clarify its anatomical basis; (2) explore the association between C2LM-NUS and atlantoaxial osteoarthritis (AAOA), and verify the related biomechanics.

Methods: Seventy-nine dry axis specimens were measured macroscopically. The vertical distance between the superior articular surface and the lower edge of the vertebra was defined as the settlement value of C2 lateral mass (C2LMS). Twelve formalin-embalmed axis specimens were scanned using micro-computed tomography (Micro-CT), and the trabecular microstructure of lateral masses was analyzed. 522 patients who underwent a head and neck or cervical spine CT scan were reviewed. The C2LMS was measured, and the bilateral difference (d-C2LMS) was calculated. The AAOA was recorded. Normal and C2LM-NUS upper cervical spine (C0-C3) finite element models were established. The stress distributions on the alar ligament, transverse ligament, and lateral mass cartilage were analyzed using Abaqus software under varying torque conditions.

Results: Macroscopic analysis revealed that the C2LMS measured at the center point was comparable to the overall C2LMS (18.19 ± 1.83 mm vs. 18.18 ± 1.82 mm, p = 0.942). Twenty-seven dry axis specimens (34.2%) were identified as C2LM-NUS because they showed significant differences in bilateral C2LMS (d-C2LMS: 1.21 ± 0.32 mm). Micro-CT analysis revealed that four formalin-embalmed axis specimens with C2LM-NUS exhibited a substantial difference in trabecular microstructural parameters between the settlement and the normal lateral masses. Clinical observations indicated that C2LM-NUS was an independent risk factor for AAOA (adjusted odds ratio = 2.041, p < 0.001). Finite element analysis revealed that in the C2LM-NUS model, the maximum stress on the settlement side of the alar ligament increased by 47.4%–53.3% compared to the opposite side, and the cartilage stress increased by 15.0%–68.5%. Meanwhile, the maximum stress of the transverse ligament in the C2LM-NUS model was 1.3–1.6 times greater than that of the normal model.

Conclusions: The macroscopic measurement of the axis specimens provided objective anatomic evidence for C2LM-NUS. Micro-CT showed that C2LM-NUS was associated with asymmetrical alterations of the trabecular microstructure of the lateral masses, suggesting that it is a pathological change rather than a normal phenomenon. The clinical study indicated that C2LM-NUS is an independent risk factor for AAOA. Stress concentration in unilateral alar ligaments and articular cartilage is a biomechanical contributor to AAOA.

Introduction: Acute lateral ankle sprain (LAS) frequently results in persistent functional limitations. Understanding changes in calf muscle and Achilles tendon (AT) stiffness after LAS may shed light on mechanisms underlying impaired function.

Objective: To investigate the effects of acute LAS on the mechanical properties of the calf muscles and the Achilles tendon, ankle function, pain, edema, and strength.

Methods: This controlled observational study was conducted from August 2023 to January 2025. Fourteen participants with acute LAS and 14 healthy controls were evaluated twice, 6 weeks apart. Shear wave elastography (SWE) assessed the stiffness of the triceps surae and AT. Ankle function, pain, and edema were evaluated using the Foot and Ankle Outcome Score, Visual Analog Scale, and figure-of-eight method. Plantar flexion strength was measured via isometric dynamometry.

Results: No significant differences in stiffness were found between or within groups (soleus: p = 0.932; MG: p = 0.760; LG: p = 0.800; AT: p = 0.070), although a time effect (p = 0.005, η² = 0.269) indicated a general increase in AT stiffness over time (MD = −0.72, p = 0.05, d = 2.86). At baseline, the LAS group exhibited reduced ankle function (MD = 3.43, p < 0.001, d = 2.20), increased pain (MD = 1.88, p < 0.001, d = 1.86), and greater edema (MD = −51.27, p < 0.001, d = −3.58). Over time, improvements were noted in function (MD = −37.04, p < 0.001, d = 2.27), pain (MD = 2.66, p < 0.001, d = −1.31), and edema (MD = 1.07, p = 0.014, d = −0.95), but ankle function remained lower in the LAS group at follow-up (MD = −14.17, p < 0.001, d = −1.79). For plantar flexion strength, no group × time interaction was found (p = 0.745), but a group effect indicated lower peak torque in the LAS group (MD = −32.05, p = 0.012, d = −3.82). A time effect (p < 0.001, η² = 0.622) showed increased torque across both groups (MD = −18.74, p < 0.001, d = 3.07).

Conclusion: LAS reduces ankle function and leads to pain and edema but does not induce notable changes in calf muscle or AT stiffness within 6 weeks.

Objective: Lumbar lateral recess stenosis (LRS) with subligamentous disc herniation often causes debilitating radicular pain. While discectomy is commonly performed, it risks disc degeneration and spinal instability. This study aimed to evaluate the clinical and radiographic outcomes of full-endoscopic interlaminar standalone decompression as a minimally invasive, disc-preserving alternative to discectomy for treating single-level LRS with subligamentous disc herniation.

Methods: We retrospectively reviewed 55 patients with single-level lumbar LRS and subligamentous disc herniation who underwent full-endoscopic interlaminar standalone decompression between 2013 and 2021. Inclusion criteria required radicular pain refractory to conservative treatment and magnetic resonance imaging (MRI) confirmation of subligamentous herniation. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), and Short Form-12 Physical and Mental Component Scores (SF-12 PCS/MCS). Radiographic evaluations included disc height index (DHI) measurements and Bartynski grading for lateral recess stenosis. Pre- and postoperative data were compared using the Wilcoxon signed-rank test.

Results: At the 2-year follow-up, leg and back pain VAS scores improved significantly from 8.8 and 8.5 preoperatively to 1.0 and 0.9, respectively. ODI scores declined from 66.9 to 10.6, while SF-12 PCS and MCS improved from 30.1 to 42.5 and 26.3 to 42.6, respectively. According to the modified MacNab criteria, 96.3% of patients achieved “good” or “excellent” outcomes. Postoperative DHI remained stable, and no reoperations were required during follow-up.

Conclusions: Full-endoscopic interlaminar standalone decompression offers substantial symptom relief and functional improvement for single-level lumbar LRS with subligamentous disc herniation. By preserving disc integrity, this minimally invasive technique avoids the risks associated with discectomy, such as disc degeneration and instability. These findings suggest a paradigm shift in treating LRS, supporting the use of this disc-preserving approach as a viable alternative to conventional surgical methods in properly selected patients. Further research with larger cohorts and longer follow-up is warranted to validate these results.

Background: Antibiotic-loaded cement (ALC) is often used to reduce the risk of surgical site infections (SSIs) in hip hemiarthroplasty; however, controversy exists regarding the use of dual antibiotic-loaded cement (DALC) and single antibiotic-loaded cement (SALC).

Objective: This systematic review and meta-analysis compare the efficacy of DALC and SALC for hip hemiarthroplasty.

Methods: For this systematic review, a search was undertaken in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov. Grey literature such as ProQuest Dissertations and Theses Global (PQDT) was also explored. The inclusion criteria comprised randomized controlled trials (RCTs) or comparative observational studies, and patients undergoing hip hemiarthroplasty with DALC or SALC. Newcastle–Ottawa Scale (NOS) and RoB 2.0 tools were used for risk of bias assessment in observational and RCTs, respectively. Review Manager (RevMan, version 5.4.1; The Cochrane Collaboration, Copenhagen, Denmark) was used for statistical analysis. The primary outcome was the incidence of deep SSIs.

Results: A total of five articles, including 28,418 participants, met the inclusion criteria. Three of the included studies were retrospective studies, one quasi-randomized study, and one RCT. The primary outcome revealed that DALC was associated with a statistically significant reduction in deep SSIs compared to SALC (RR, 0.47; 95% CI, 0.29–0.76; p = 0.002; I² = 27%). Subgroup analysis based on the study design did not show a significant difference for deep SSIs (p = 0.29). The majority of the secondary outcomes, such as superficial SSIs, mortality, participants with ≥ 1 complication, or antibiotic use, did not show any significant difference. However, DALC significantly lowered the risk of any infection (RR, 0.55; 95% CI, 0.38–0.79; p = 0.001; I² = 27%).

Conclusion: In conclusion, DALC can significantly reduce the risk of SSIs and the overall rate of any infection in hip hemiarthroplasty. A limitation of this study is that RCTs were pooled with observational studies, which decreased the power of analysis. Therefore, further research, including large RCTs, is needed to validate these findings.

Background: Component alignment is a key factor influencing clinical outcomes after total knee arthroplasty (TKA). Previous studies have shown that single-plane alignment can significantly affect knee joint kinematics and biomechanics. However, the comprehensive impact of multiplanar malalignment has been rarely investigated.

Objective: This study aimed to investigate the influence of the multiplanar malalignment combination on the polyethylene tibial liners under gait loading, a primary activity of daily life, as well as the degree of the influence of the alignments on the different planes.

Method: A validated finite element model of a cruciate-retaining knee prosthesis under gait loading was used in this study. Five alignment parameters (−5°, −3°, 0°, 3°, 5°) on each plane (coronal, sagittal, and transverse) were selected to simulate clinical alignment errors, resulting in 125 models combining various alignment errors across the three planes. Boundary and loading conditions were set according to ISO 14243-3:2014. The maximum von Mises stress and contact stress during a gait cycle were recorded for statistical analysis. A polynomial model was used for regression analysis, with the degree of influence of each alignment error on von Mises and contact stress determined by examining the quadratic coefficients.

Results: The highest Mises and contact stress values occurred with alignment errors of 5° varus, 5° flexion, and 5° internal rotation on the coronal, sagittal, and transverse planes, respectively. The lowest stress values were observed with a combination of 3° valgus, 5° flexion, and 0° internal rotation. The regression analysis yielded an R² value of 0.69 between alignment errors and Mises stress, with quadratic coefficients of 0.096, 0.013, and 0.064 for the coronal, sagittal, and transverse alignments, respectively. For contact stress, the R² was 0.697, with quadratic coefficients of 0.083, 0.002, and 0.026 for the coronal, sagittal, and transverse alignments, respectively.

Conclusion: The coronal alignment of the lower limb has the most significant impact on both Mises stress and contact stress of the tibial liner, followed by the rotational alignment of the tibial component. In contrast, the sagittal alignment of the femoral component has the least influence.

Objective: Adolescent scoliosis patients frequently experience social alienation, yet comprehensive studies addressing its determinants in China remain scarce. This study aims to understand the current status of social alienation in adolescent scoliosis patients and analyze its influencing factors to inform targeted interventions.

Methods: A cross-sectional study was conducted from January 2022 to December 2023. A total of 252 adolescent scoliosis patients were investigated using the General Information Questionnaire, Social Alienation Scale, Family Care Scale, and Anxiety Self-Rating Scale. Multivariate linear regression analysis was employed to identify independent factors influencing social alienation.

Results: Adolescent patients with scoliosis experience significant social isolation (37.21 ± 0.78), lower levels of family care (6.33 ± 0.70), and higher anxiety self-assessment scores (53.11 ± 0.88), and the results showed that education level, per capita monthly family income, time of disease onset, type of scoliosis, Cobb's angle, ability to take care of oneself, appearance deformation, family care, and anxiety were found to independently influence the social alienation score (all p < 0.05).

Conclusion: Adolescent patients with scoliosis exhibit a heightened degree of social isolation due to a variety of factors. Healthcare professionals should focus on providing individualized interventions, particularly for those with lower levels of education and family support, to alleviate their social isolation.

Objective: With the characteristics of population change, geriatric hip fracture is increasing, accompanied by high morbidity and mortality rates. However, limited research has thoroughly investigated the postsurgery functional outcomes of hip fractures in the elderly population.

Methods: This study included 993 patients who underwent hip fracture surgery, drawn from a prospective cohort in China. Demographic and clinical data were collected for all participants. The cohort was randomly divided into training and validation sets (8:2). Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analyses were employed to identify predictive factors for hip function at 12 months postoperatively. A nomogram was developed using R software and evaluated using concordance index (C-indexes), area under the curve (AUC), decision curve analysis (DCA), and calibration curves.

Results: Patients were divided into training (n = 794) and validation set (n = 199). Eight independent predictive variables for the poor functional outcome (Harris Hip Score < 80) after hip fracture include age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04–1.12), hypertension history (OR, 2.53; 95% CI, 1.50–4.23), fracture type (OR, 0.28; 95% CI, 0.17–0.48), blood transfusion (OR, 2.30; 95% CI, 1.35–3.94), baseline PARKER score (OR, 0.85; 95% CI, 0.75–0.97), adverse events occurred within 12 months postoperatively (OR, 5.49; 95% CI, 2.30–13.08), transfer to the rehabilitation institution (OR, 3.22; 95% CI, 1.51–6.88), and time from surgery to weight-bearing (OR, 1.02; 95% CI, 1.01–1.03). The nomogram demonstrated excellent predictive ability in the training set (AUC = 0.853, [95% CI: 0.816–0.890]). Furthermore, according to the calibration curve, the model's prediction and actual observation were in good consistency, and the DCA curve demonstrated good clinical usefulness.

Conclusions: This study developed a personalized, predictive nomogram with eight risk factors for predicting 1-year functional outcomes in geriatric patients with hip fractures. Our model facilitates the early identification of high-risk patients and enables surgeons to implement timely preventive interventions.

Objective: Titanium mini-plates are applied in unilateral open-door laminoplasty to secure the elevated laminae and prevent re-closure. Whereas the conventional technique fixates every level, some surgeons plate only alternate levels to curb implant costs. Whether they could achieve similar long-term clinical and radiographic efficacy is still questionable. This study aimed to compare the efficacy and safety of alternative-level fixation versus all-level fixation in cervical laminoplasty for multilevel cervical spondylotic myelopathy (CSM).

Methods: A retrospective analysis is conducted on 65 patients who underwent C3–C7 unilateral laminoplasty at Peking University People's Hospital from July 2012 to December 2020. Patients are divided into two groups: alternative-level fixation and all-level fixation. Clinical outcomes, including operative time, intraoperative blood loss, postoperative hospitalization days, and complications, are assessed. The Japanese Orthopaedic Association (JOA) score is used for neurological function evaluation, while pain is assessed with the Visual Analog Scale (VAS). Radiographic outcomes include changes in anterior–posterior diameter, Pavlov ratio, cervical lordosis (CL), thoracic slope (T1S), and sagittal vertical axis (SVA).

Results: Both groups showed significant improvements in JOA (15.94 ± 0.85 vs. 8.74 ± 1.76 in alternative-level and 16.1 ± 0.79 vs. 8.42 ± 1.84 in all-level) and VAS (1.03 ± 0.87 vs. 5.79 ± 1.18 in alternative-level, 1.06 ± 0.77 vs. 5.35 ± 1.17 in all-level) postoperatively, with no statistically significant differences in clinical outcomes between the groups (JOA: 15.94 ± 0.85 vs. 16.1 ± 0.79, p = 0.394; VAS: 1.03 ± 0.87 vs. 1.06 ± 0.77, p = 0.432). Although total hospital costs are significantly lower in the alternative-level fixation group (124,937 ± 5104.01 RMB vs. 88007.53 ± 7014.53, p < 0.001), the all-level fixation group demonstrated better long-term preservation of APD (17.87 ± 0.60 vs. 17.50 ± 0.52) at the final follow-up. Radiographic outcomes, including CL, T1s, and cSVA, show no significant differences between the two groups, indicating comparable spinal alignment outcomes.

Conclusion: Both all-level and alternative-level fixation methods effectively support the lamina and prevent reclosure, with significant improvement in clinical symptoms in both groups at the final follow-up, showing no significant difference in postoperative clinical outcomes between the two. There are no differences in sagittal parameters. All-level fixation method showed better preservation of the spinal canal diameter.

Objectives: The Schroth method is considered potentially valuable as an alternative intervention to control curve progression in mild to moderate adolescent idiopathic scoliosis. However, patients are often dependent on the subjective experience of the physiotherapist when practicing, as changes in spinal alignment and muscle activation are unknown. The aim of this study was to evaluate the effectiveness of the Schroth method for spinal alignment and muscle activation in adolescents with idiopathic scoliosis (AIS).

Methods: This prospective cross-sectional study, conducted at the Scoliosis Engineering Center of Guangzhou Sport University (January 2020–October 2022), enrolled 36 AIS (4 males, 32 females; age 13.2 ± 1.8 years) presenting major thoracic curvature (Cobb angle: 10°–40°, Risser stage 0–4). Participants underwent a standardized 1-week pretraining protocol before performing four Schroth exercises (“50 × Pezziball,” sail, muscle cylinder, and corrected standing). Real-time spinal ultrasound angles (SUAs) and paraspinal muscle activation (via surface electromyography, sEMG) were quantified during habitual standing (baseline) and exercise conditions. Normality was verified using Kolmogorov–Smirnov tests. Within-group comparisons employed paired t-tests (effect sizes: Cohen's d; 95% CIs), while proximal thoracic (PT) compensation frequencies were assessed via chi-squared tests.

Results: All four Schroth exercises significantly reduced the SUA of the primary thoracic curve compared to habitual standing (p < 0.05). The lumbar curve SUA decreased specifically after “50 × Pezziball” and muscle cylinder exercises (p < 0.05). PT curve compensation frequency rose from 16.7% (6/36) in habitual standing to 33.3% (12/36) and 30.6% (11/36) during “50 × Pezziball” and sail exercises, respectively (p < 0.05). sEMG demonstrated reduced paravertebral muscle (PSM) activation asymmetry at the thoracic apex (T8) during corrective standing, “50 × Pezziball,” and sail exercises (p < 0.05). However, “50 × Pezziball” and sail exercises triggered compensatory left-dominant PSM imbalance at T2 (p < 0.05). At lumbar levels (L2–L5), performing 50 × Pezziball exercise exacerbated asymmetry (p < 0.05), whereas muscle cylinder exercises reversed the activation patterns of the PSM (p < 0.05).

Conclusion: While Schroth exercises effectively reduced thoracic curvature and improved T8 muscle symmetry, caution is warranted during “50 × Pezziball” and sail exercises due to increased PT compensation and lumbar/T2 muscle imbalances. Muscle cylinder exercises may mitigate adverse lumbar effects.

Objective: Hemivertebrae in the cervicothoracic junction in the pediatric population are treated conventionally with a two-rod instrumentation pattern. However, the increase in complexity, severity, and immaturity of osseous malformation in the cervicothoracic spine presents additional challenges in construct planning. This study aims to introduce an integrated instrumentation strategy named the sequential correction technique in the treatment of congenital cervicothoracic scoliosis caused by hemivertebra (CTS-HV) and evaluate its feasibility and treatment effects.

Methods: We retrospectively analyzed a consecutive series of patients with CTS-HV who underwent posterior-only HV resection with sequential correction technique from March 2018 to November 2023. This technique employed multiple rods, each being designated for a specific task, to sequentially perform surgical maneuvers involving osteotomy closure, torticollis correction, and implant integration. Individualized adjustments on instrumentation configuration involving rod number, rod type (whole, segmental, or satellite), cervical anchor choice, and connector placement could be made according to the severity of CTS and cervical pedicle dysplasia. Radiographic deformity parameters of the head–neck–shoulder complex were measured preoperatively, postoperatively, and at the latest follow-up. One-way repeated measures analysis of variance and Bonferroni correction were used to compare data at different time points. Additionally, any complications that occurred intraoperatively and during follow-up would be recorded.

Results: Twenty-two pediatric and adolescent patients were recruited with a mean age of 8.3 ± 3.7 years. The ratio for the location of the resected CTS-HVs were C6 (4.6%), C7 (13.6%), T1 (31.8%), T2 (9.1%), T3 (27.6%), and T4 (13.6%). All patients were instrumented with screw-hook hybrid constructs, of which 3-rod and 4-rod constructs accounted for 81.8% and 18.2%, respectively. The cervicothoracic scoliosis, T1 tilt, neck tilt, clavicular angle, head tilt, and head shift were all significantly corrected from 53.1° ± 11.4°, 25.3° ± 10.1°, 19.6° ± 9.3°, 4.5° ± 3.1°, 10.7° ± 8.3°, and 21.8 ± 18.0 mm preoperatively to 20.8° ± 7.6°, 14.4° ± 7.2°, 7.3° ± 6.5°, 2.3° ± 2.6°, 4.4° ± 2.5°, and 9.8 ± 8.8 mm postoperatively (all p < 0.05). No significant correction loss was observed at the final follow-up (all p > 0.05). The incidences of intraoperative dural tear and iatrogenic Horner's syndrome were both 4.6%. Transitory bilateral nerve root paralysis causing upper limb dysfunction occurred in 1 patient. Additionally, 3 patients suffered severe distal curve progression with trunk tilt and were surgically revised with instrumentation extending to the stable zone. No implant-related complications were observed.

Conclusions: This modified sequential correction technique possesses the merits of easy rod installation, satisfying torticollis correction, good symmetry and verticality of the entire instrumentation, and high fixation rigidity with multi-rod constructs across the cervicothoracic junction. Thus, it is endowed with great application values in the treatment of CTS.

Objective: Anterior cervical discectomy and fusion (ACDF) is a trans-intervertebral space procedure with limited ability to treat compression at the back of the vertebral body. Anterior cervical corpectomy and fusion (ACCF) can be applied in this case, but the higher complication rates restrict its usage. This study aims to describe an ACDF-based procedure named anterior cervical V-shaped osteotomy and fusion (ACVF) with a long axial decompression range while preserving the intact anterior half of the vertebral body.

Method: Four patients with contiguous two-level degenerative cervical myelopathy who underwent ACVF with 12-month follow-up were retrospectively reviewed. Intraoperatively, an electrode penetration test was conducted to verify complete decompression. Clinical outcomes were evaluated using the modified Japanese Orthopedic Association (mJOA) score and the Visual Analog Scale (VAS) score. Radiological examinations, including computed tomography (CT) and magnetic resonance imaging (MRI), were used to assess spinal cord decompression and intervertebral fusion.

Results: All surgeries were successfully completed with an average operative time of 182 min. Both the mJOA score and the VAS score improved at the follow-ups postoperatively. Postoperative imaging showed thorough decompression of the spinal cord, unimpaired fusion process, and acceptable vertebral body height loss.

Conclusions: ACVF may be safe and effective for spinal cord direct decompression in the case of retro-corporeal compression, with the potential to serve as a substitute for ACCF and avoid the complications associated with long-strut grafts.

Objective: Benign bone lesions involving the femoral head are common in pediatric populations but pose significant challenges due to anatomical complexity and the need to preserve growth plate integrity. This study aims to evaluate the efficacy of the trapdoor procedure in treating these lesions in skeletally immature patients.

Methods: From 2013 to 2023, five pediatric patients with femoral head bone lesions were identified who underwent the trapdoor procedure retrospectively. Preoperative assessments included computed tomography (CT) and magnetic resonance imaging (MRI). Follow-up spanned a mean of 37.8 ± 11.2 months, with attention to pathology, recurrence, and complications. Functional outcomes were assessed using the McKay clinical grading method.

Results: Histological examination postoperatively confirmed Langerhans cell histiocytosis (LCH) in two patients and chondroblastoma in two others. One patient's diagnosis remained unclear, indicating only fibrous tissue cell proliferation. No recurrences were observed, but avascular necrosis (AVN) occurred in both LCH patients, necessitating revision surgery.

Conclusions: The trapdoor procedure is a safe and effective method for treating benign bone lesions of the femoral head in children, with attention needed for the potential of AVN.

Objective: Spondyloptosis (Grade-V spondylolisthesis) is the most severe form of spondylolisthesis and presents significant surgical challenges due to its rarity and complexity. This study aimed to outline the key aspects of posterior-only L5 partial spondylectomy and reduction of L4 onto S1 for spondyloptosis, as well as evaluate the clinical outcomes and prospects of this technique.

Methods: Three patients diagnosed with L5/S1 spondyloptosis between July 2022 and June 2023 were assessed. All these patients underwent posterior-only L5 partial spondylectomy with L4–S1 reduction, using a modified Kebaish's technique. The surgical approach was described in detail, and patient outcomes were assessed through postoperative imaging and clinical measures.

Results: The mean age of the patients was 28.7 years (range, 13–41). Preoperative assessments showed a mean Visual Analog Scale (VAS) score for low back or lower limb pain of 5.3 (range 5–6), an Oswestry Disability Index (ODI) of 57.3% (40%–74%), and a Japanese Orthopedic Association-29 (JOA-29) score of 15.7 (13–19). The mean operative time was 469 min (455–483), with a mean estimated blood loss of 1400 mL (1200–2000). The average follow-up duration was 14 months (12–18). At the final follow-up, all the patients achieved solid fusion, confirmed via computed tomography. Postoperative VAS, ODI, and JOA-29 scores improved to 2 (0–3), 17.3% (6%–26%), and 23 (22–25), respectively. All the patients reported high satisfaction with the treatment.

Conclusions: Posterior-only L5 partial spondylectomy with L4–S1 reduction is a feasible and effective treatment for lumbar spondyloptosis. Although technically demanding and associated with a high risk of nerve palsy, this approach can yield favorable clinical outcomes when applied appropriately in these challenging cases.

Background: Medial patellofemoral ligament (MPFL) reconstruction alone is not effective for patellar instability associated with anatomic abnormalities of lower limbs. In this article, we report a case of complex lower limb malformations, including genu valgus, lower limb shortening, and increased femoral anteversion angle. In addition to MPFL reconstruction, we performed a rare osteotomy named combined distal femoral osteotomy (CDFO), which combined the characteristics of lateral opening wedge distal femoral osteotomy (LOWDFO) and derotational distal femoral osteotomy (DDFO).

Case Presentation: We report the case of a 52-year-old female with left knee pain, valgus, and instability who was diagnosed with patellar instability and valgus knee osteoarthritis. Considering the patient's relatively young age, a hip-knee-ankle angle (HKA) of 194°, a mechanical lateral distal femoral angle (mLDFA) of 77.5°, a shortened left lower limb of 7 mm, an increased femoral anteversion angle (FAA) of 37.4°, and a patellar instability, we performed MPFL reconstruction and CDFO treatment. In this procedure, computer-aided design (CAD) combined 3D-printed osteotomy guide-assisted CDFO and MPFL reconstruction were performed. At 6-month follow-up, the patient achieved satisfactory results, with an HKA of 180°, an mLDFA of 90°, an FAA of 15°, the same length of lower limbs, and patellar stability. There was significant improvement in her left knee pain, function, and patellar stability.

Conclusions: To our knowledge, this rare pattern of patellar instability has not been previously described. Careful analysis of anatomic abnormalities is of great clinical significance and can better guide clinical treatment. CDFO may be an acceptable treatment for patellar instability with genu valgus and increased femoral anteversion angle.

Background: Posttraumatic elbow stiffness together with severe bony deformity of the distal humerus poses a great challenge for elbow surgery specialists. For young and high-demand patients suffering from grievous bony deformity but with no/mild joint degeneration, total elbow arthroplasty is not a suitable option, and hemiarthroplasty often results in a significant amount of bone stock loss, making it difficult to perform a revision procedure. Resurfacing arthroplasty has been applied in the shoulder, hip, and knee joints, as well as the radiocapitellar joint. However, resurfacing arthroplasty for the entire distal humeral articular surface was not available among current clinical studies.

Case Presentation: We report a case of a 66-year-old male patient who presented with elbow stiffness and grievous malunion of the distal humerus due to delayed treatment after a distal humerus fracture. However, there was only mild joint degeneration observed at the proximal ulna and radius owing to long-term functional impairment. Total elbow replacement was not suitable considering certain inevitable manual labor he must attend. We customized a cementless and stemless resurfacing prosthesis for the distal humerus based on contralateral articular anatomy using a 3D-printing technique with Co-Cr-Mo alloy. The traditional cemented stem was replaced with criss-cross screws to provide primary stability. The bone-implant interface was covered with a 3D-printed trabecular-like porous structure for bone in-growth and several grooves designed for bone grafting, eventually forming a stable multinested mortise-and-tenon joint structure at the bone-implant interface. At the last follow-up, significant improvements in functional outcomes of the elbow joint were observed without any prosthesis-related complications. The patient was able to return to his previous manual labor and reported improved weight-bearing capability of the affected upper limb up to 25 kg without pain or instability. While he complained of postoperative ulnar nerve palsy, the symptom markedly improved at the final follow-up.

Conclusion: The novel prosthesis we have designed for resurfacing arthroplasty of the distal humerus can provide adequate primary stability and bone in-growth capability, making it a reliable alternative for patients with severe bony deformity of the distal humerus and no/mild joint degeneration at the proximal ulna and radius, particularly young patients or those with high functional demands.