Anemia is a prevalent comorbidity among patients undergoing total hip replacement (THR) surgery, significantly affecting surgical outcomes and patient prognosis. This review synthesizes current literature on the relationship between anemia and THR, with a focus on postoperative complications, recovery times, and overall patient satisfaction. While several recent meta-analyses have quantified the risks associated with anemia, our review offers a novel perspective by linking cellular mechanisms to clinical management strategies. We analyze various studies that highlight the prevalence of anemia in this patient population and its potential impact on surgical risks, including increased rates of transfusion, infection, and prolonged hospital stays. Furthermore, we explore the implications of anemia on functional recovery and long-term outcomes, emphasizing the necessity for preoperative screening and management strategies. Our findings suggest that addressing anemia before THR may improve surgical outcomes and enhance patients' quality of life. This review underscores the importance of a multidisciplinary approach in the preoperative assessment and management of patients with anemia undergoing total hip replacement surgery.
Steroid-induced osteonecrosis of the femoral head is a severe osteoarticular condition resulting from glucocorticoid overuse, characterized by femoral head bone structure collapse and cell death, now predominant among nontraumatic femoral head necroses. The increasing clinical use of glucocorticoids has led to a rise in the incidence of steroid-induced osteonecrosis of the femoral head, yet its precise molecular mechanisms remain incompletely understood, posing challenges for clinical management. This review proposes that the “GC-induced metabolic-inflammatory-oxidative stress vicious cycle” serves as the core driver propelling the activation of the SONFH multi-pathway PCD network. Centered on this thesis, the review systematically examines the synergistic and antagonistic interactions among PCD pathways—including pyroptosis, autophagy, and ferroptosis—in SONFH, emphasizing the pivotal role of mitochondrial dysfunction and ROS bursts. This framework not only integrates the independent functions of each PCD pathway but also reveals their interwoven molecular networks, offering novel perspectives for developing multi-target synergistic therapeutic strategies.
To assess whether surgical treatment with predominantly volar locking plates has superior clinical and radiographic outcomes to conservative treatment with cast immobilization in the treatment of distal radius fractures by reviewing and investigating the literature with a high level of evidence. Thus, we systematically searched PubMed, Web of Science, and Embase databases for clinical trials comparing surgical and conservative treatments for distal radius fractures. Data extraction was performed to access parameters that included: wrist functional assessment, such as mobility and grip strength; subjective outcomes, such as DASH score, PRWE score, and quality of life score (EQ-5D); radiographic assessment (palmar inclination, ulnar variance, and articular subluxation, etc.); and complications, such as fracture nonunion, reoperation, infection, and neurologic symptoms, and then to conduct data organization and quantitative synthesis. Finally, a total of 19 clinical trials with 2729 patients were included in this report, including 1378 in the conservative treatment group and 1351 in the surgical treatment group. In terms of recovery of wrist function, wrist joints undergoing cast immobilization gained a greater range of extension (MD 1.5°, p = 0.02), whereas surgical treatment of the range of wrist rotation was significantly greater than with conservative treatment (MD 3°, p = 0.03), and wrist grip strength was significantly improved (MD 2 kg, p = 0.04). There were no significant differences between the two groups of patients in terms of wrist flexion and anterior rotation activities. In terms of patient subjective scores, patients in the plaster immobilization group showed significant improvement in PRWE scores compared with the surgical treatment group at 3 and 12 months after treatment (MD 3–7 points, p < 0.05). There was no significant difference between the two groups in terms of ulnar varus and dorsal tilt angle correction (p > 0.05). At the level of complications, the overall complication rate was significantly lower in patients who underwent surgical treatment than in the conservative treatment group (202/1046 [19.3%] vs. 361/1065 [33.9%], p = 0.001). The conclusions drawn were that when treating distal radius fractures, surgical treatment with predominantly metacarpal plate fixation achieves superior anatomical fracture repositioning and a lower complication rate compared to cast immobilization. However, no significant advantage was demonstrated in terms of recovery of wrist function and subjective patient perception. Overall, surgical treatment is an appropriate choice for patients with high motor function requirements who need to recover quickly, whereas more conservative treatments can be considered for patients with lower functional requirements.
Objectives: Over the past three decades, orthopedic surgical robots have experienced rapid advancements. This study, a case series, aimed to investigate the effectiveness, limitations, and technical improvements associated with the application of robots in the surgical treatment of bone tumors.
Methods: From November 2021 to October 2023, 54 patients with bone tumors who provided consent for robot-assisted surgery were included. Patients were divided into three groups based on specific objectives: robot-assisted path planning, pedicle screw insertion, and intraoperative real-time navigation-assisted tumor resection. Perioperative conditions were meticulously recorded for all patients, including intraoperative blood loss, operation duration, postoperative complications, and tumor diameter.
Results: Nineteen patients underwent robot-assisted tissue biopsies, and pathological examinations confirmed a positive rate of 84.21%. Among the 21 patients undergoing robot-assisted pedicle screw placement, surgical planning was executed with high accuracy. Twenty patients undergoing robot-assisted lesion excision achieved precise resection of the tumor-affected bone segments as planned preoperatively, and no secondary osteotomies were required. No perioperative complications related to the use of robots were observed in the 54 patients. To address the limitation of orthopedic robots in differentiating soft tissues, we integrated ultrasound technology and the da Vinci robot. Additionally, patient-specific cutting guides were utilized to compensate for the prolonged operation time associated with planar planning using orthopedic robots.
Conclusions: Robot-assisted technology facilitates the precise planning of the surgical path and determination of the osteotomy plane. The integration of orthopedic robots with intraoperative ultrasound or Da Vinci robots can potentially further ensure the safety of bone tumor surgery while maintaining its accuracy, thereby minimizing the risk of complications associated with surgical procedures. Furthermore, this technology combined with patient-specific cutting guides may be conducive to reducing operation time.
Objectives: Patellar malalignment (PM) is common and a deformed valgus knee is an uncommon contributing factor. A deformed valgus knee can magnify the traction forces laterally during knee extension, consequently leading to PM. Treatment of combined disorders without correction of the deformed valgus knee is often less effective. The objective of this study was to assess the possibility of using the retrograde intramedullary nailing technique with some modifications for the treatment of both disorders.
Methods: From January 2011 to December 2020, 36 consecutive adult patients with 36 combined disorders underwent surgical treatment. The distal femur was obliquely osteotomized by creating a posterior cam on the distal bony fragment. The cam was consequently inserted into the marrow cavity of the proximal bony fragment. After the bone marrow was reamed, a dynamically locked intramedullary nail was inserted using the retrograde technique. A lateral retinacular release was performed on the patella, and the articular surfaces of the lateral patellar facet and lateral femoral condyle were drilled. The chi-square test was used to analyze categorical data and the Mann–Whitney U test was used to analyze numerical data.
Results: Thirty-two patients were followed for an average of 2.8 years (range, 1.7–5.4 years) and all osteotomized sites healed (average, 2.8 months). All 32 deformed valgus knees were corrected to the acceptable axis (from an average of valgus 10° initially to valgus 2° finally in 32 knees on the mechanical axis, p < 0.001). All PM had improved congruence angle, lateral patellofemoral angle, and patellofemoral index (p < 0.001 in all three). Both the tibiofemoral and patellofemoral joints achieved satisfactory function in all patients (p < 0.001).
Conclusion: The described technique can concomitantly treat both the tibiofemoral and patellofemoral joints. Although the technique is relatively simple, the effect is remarkable, and the success rate is high. Therefore, it may be a valuable alternative for the treatment of combined disorders.
Objective: The posterior minimally invasive approaches for odontoid fractures include the midline nuchal ligament approach (MNLA) and the paramedian muscle-splitting approach (PMSA). However comparative data on their anatomical characteristics and clinical efficacy remain scarce to date. The objective of this study is to determine the differences in anatomy and clinical outcomes between the MNLA and the PMSA for reduction and temporary internal fixation of odontoid fractures.
Methods: This retrospective analysis focused on 31 patients with odontoid fractures from February 2021 to December 2023. Among them,16 patients underwent PMSA and 15 patients underwent MNLA. Various parameters were compared between the two groups, including operation time, intraoperative blood loss, postoperative complications, edema rates of cervical posterior muscles, the range of motion in rotation of C1–C2, patient satisfaction, Visual Analogue Scale score for neck pain, axial symptom scores, and neck disability index. Additionally, an anatomical study was performed; the PMSA and the MNLA were simulated on six fresh cadaveric specimens to compare the anatomical differences in surgical exposure between the two approaches.
Results: In the clinical study, both groups successfully achieved fracture healing. Compared with the PMSA group, the MNLA group had several advantages, including shorter operative times, lower intraoperative blood loss, and a lower edema rate of posterior cervical muscles. However, similar results were observed between the two groups in terms of the range of motion in rotation of C1–C2, patient satisfaction, Visual Analogue Scale score for neck pain, axial symptom scores, and neck disability index at the last follow-up. In the cadaveric study, we found the trapezius-splenius capitis interface and the course of the greater occipital nerve (GON) varied significantly and the GON was present in the surgical field in 2 of 6 specimens in the PMSA, which brought difficulties for the surgical operation. In contrast, the MNLA, using the spinous process of C2 and the obliquus capitis inferior (OCI) as anatomical landmarks, provided a simpler surgical procedure and easier exposure.
Conclusion: Both the MNLA and the PMSA demonstrated favorable clinical outcomes for the treatment of odontoid fractures. However, compared with the PMSA, the MNLA, using the spinous process of C2 and the OCI as anatomical landmarks, offers advantages of the stability of the surgical procedure, easy exposure, and reduced iatrogenic damage to the cervical posterior muscles and GON.
Objective: There are limited data about the association between intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging and surgical outcome in degenerative cervical myelopathy (DCM) after anterior decompressive surgery. This study aimed to explore factors contributing to unsatisfactory recovery following surgical treatment for DCM, with a particular focus on evaluating whether preoperative quantitative indicators of ISI on T2-weighted MRI could be used to forecast surgical outcomes.
Methods: In this retrospective analysis, 94 patients diagnosed with ISI and treated with anterior cervical decompression for DCM between January 2021 and June 2023 were reviewed. Based on a postoperative recovery rate cutoff of 50% at final follow-up, patients were categorized into optimal and suboptimal recovery groups. Multivariate logistic regression was employed to identify independent predictors of prognosis.
Results: Among the 94 patients, 39 (41.5%) had a suboptimal clinical outcome with a recovery rate below 50%. Multivariate analysis identified longer duration of symptoms, higher signal change ratio (SCR) on T2-weighted MRI, and the presence of snake-eye appearance (SEA) as significant predictors of poor recovery. The optimal SCR cutoff value for predicting a suboptimal outcome was 1.53, yielding a sensitivity of 64.1% and a specificity of 83.6%. While somatosensory and motor evoked potentials (SEP/MEP) were associated with baseline neurological function, they did not serve as standalone predictors of recovery.
Conclusions: Longer symptom duration, elevated SCR on T2-weighted MRI, and SEA features may be significant preoperative indicators of less favorable outcomes in DCM patients. Individuals exhibiting an SCR above 1.53 and SEA on imaging should be considered at increased risk for limited postoperative improvement. These insights highlight the potential benefit of earlier surgical intervention and underscore the need for prospective validation through multicenter studies.
Objective: Dorsal articular collapse in distal radius fractures presents unique fixation challenges. While volar locking plating (VLP) dominates current practice, dorsal vertical double plating (DVDP) offers direct biomechanical support but carries perceived tendon risks. This study compares DVDP versus VLP for dorsally collapsed comminuted fractures.
Methods: A retrospective cohort of 106 patients (2022–2024) with AO type C2/C3 fractures received either VLP (n = 50) or DVDP (n = 56). General information encompassed gender, age, injured side, injury mechanism, AO classification, time from injury to surgery, operative time and complication profiles. Primary outcomes included 12-month radiographic parameters (volar tilt, ulnar inclination, and radial height), wrist range of motion (ROM), functional scores (DASH, Gartland-Werley), and complications. Continuous variables were compared using the Mann–Whitney U test. Categorical variables were analyzed with Pearson's χ2 test.
Results: The study cohort comprised 106 patients with dorsally collapsed distal radius fractures (VLP = 50, DVDP = 56). Baseline characteristics, including age (VLP median 59 years [IQR: 55–61.25] vs. DVDP 57 [53–61]), gender distribution (36% vs. 35.7% male), injury mechanism (72% vs. 71.4% falls), and AO classification (C3: 76% vs. 76.8%), showed no significant differences (all p > 0.05). At 12-month follow-up, all fractures achieved union with comparable radiographic outcomes: volar tilt (10° [8°–12°] vs. 10° [9°–12°]), ulnar inclination (22° [20°–23°] vs. 23° [22°–23°]), and radial height (11 mm [9–12] vs. 11 mm [10–12]) (all p > 0.05). Functional assessments revealed equivalent ranges of motion: dorsiflexion (69.5° [62°–76°] vs. 70° [68°–75°]), palmar flexion (68° [60°–70°] vs. 69.5° [66°–70°]), and rotation (pronation-supination: 80° [67.75°–65°]/71.5° [61.5°–81.25°] vs. 75.5° [70°–82°]/75° [68°–80°]). Patient-reported outcomes were similar: Gartland–Werley scores (5 [3–8] vs. 5 [3–7.75]) and DASH scores (12.5 [10–15.42] vs. 12.5 [12.5–15]) (all p > 0.05). Complication rates were comparable (VLP: 10% transient median neuropathy vs. DVDP: 12.5% tendon adhesions, p = 0.69), with all cases resolving conservatively within 3 months. Crucially, the DVDP group demonstrated zero tendon ruptures using tendon-sparing techniques.
Conclusion: DVDP demonstrates non-inferior functional and radiographic outcomes to VLP for dorsally collapsed fractures. With meticulous technique—including intercompartmental approaches and low-profile implants—DVDP eliminates historical tendon risks and serves as a viable surgical alternative.
Objective: Hip septic arthritis is a relatively rare yet severe cause of acute hip pain, with the potential to rapidly destroy articular cartilage, lead to osteonecrosis, and cause osteomyelitis. This life-threatening infection demands early diagnosis and appropriate treatment. Our study aims to assess the surgical safety and efficacy of arthroscopic management for this condition and to optimize the arthroscopic treatment protocol by customizing surgical interventions based on intraoperative findings and disease stages.
Methods: We conducted a retrospective study of 28 patients (18 females, 10 males; average age of 49 ± 10.5 years) from January 2018 to March 2022. Diagnosis of hip septic arthritis was confirmed via synovial fluid examination, culture, or synovial pathology. Patients underwent arthroscopic joint lavage, synovectomy, and drainage tailored to the intraoperative situation and the Gächter stage. Antibiotics were administered based on drug-sensitivity results or empirically. We recorded and analyzed symptoms, comorbidities, stages, inflammatory marker levels, culture results, antibiotic duration, outcomes, and complications.
Results: The mean time from symptom onset to surgery was 10.2 ± 8.6 (range, 4–45) days. All patients had elevated inflammatory markers. Pre-operative bacterial cultures were positive in 6 cases, and post-operative cultures were positive in 21 cases. Staphylococcus aureus was the most frequently detected pathogen (10 cases), accounting for approximately 47.6% of the positive culture cases. Antibiotic therapy lasted 4–6 weeks. The C-reactive protein normalized on average 43 days after surgery; the erythrocyte sedimentation rate normalized 54 days postoperatively. At final follow-up (mean 42 months), the visual analog scale score decreased from 6.6 ± 1.3 to 1.3 ± 0.2 (p = 0.003), and the modified Harris Hip Score improved from 52 ± 8.1 to 85 ± 8.6 (p = 0.001). Infection was controlled in all patients within 6 months. Two patients (Gächter stage III/IV) had recurrent infections at 8 and 11 months, successfully treated with repeat arthroscopy. Gächter stage III or IV was a significant risk factor for recurrence. Two patients underwent total hip arthroplasty due to secondary osteoarthritis and osteonecrosis. No major complications occurred.
Conclusion: Stage-based arthroscopic lavage, synovectomy, and drainage combined with antibiotics is effective for hip septic arthritis. The optimized procedure offers a safe and effective option, particularly for early-stage (Gächter I–II) disease, while advanced stages (III–IV) require cautious management due to higher recurrence risk.
Objective: This study aimed to analyze the bone mineral density (BMD) in various body regions, investigate the effects of age and sex on BMD, and characterize BMD variations among different lumbar segments (L1–L4). Thereby uncovering patterns of regional bone loss, quantifying heterogeneity risks, and dynamically tracking individual trajectories.
Methods: BMD was measured using dual-energy x-ray absorptiometry (DXA). Patients were stratified to analyze the effects of age and sex on BMD at the following sites: lumbar spine (L1–L4); femur: Ward's triangle, greater trochanter, femoral shaft, femoral neck, upper femoral neck, and lower femoral neck; and head, ribs, and pelvis. Subgroup analyses were conducted based on age, BMD Z-scores, BMD T-scores, and body mass index (BMI) to compare lumbar segmental BMD (L1–L4) between the sexes. The study conducted from 2019 to 2024 included lumbar spine data from 20,199 patients; femur data from 23,218 patients; and head, ribs, and pelvis data from 1288 patients.
Results: In males, the BMD at the femoral Ward's triangle, femoral shaft, and femoral neck (including the upper and lower regions) began to decline from 45 to 49 years of age. The BMD of the femoral greater trochanter decreased at 50–54 years of age. The head BMD in males decreased at 55–59 years of age. The rib BMD showed no significant age-related changes, though the pelvic BMD decreased at 60–64 years. In females, the head, femoral greater trochanter, and femoral shaft BMD decreased at 45–49 years of age.In male patients aged 50–89 years and female patients aged 40–89 years, male and female patients in the Z > −2.0 group, male and female patients in the BMD T-score stratification groups, male patients with a BMI < 30 kg/m2, the BMDs of L1 and L2 were significantly lower than those of L3 and L4 among different age groups. The BMD of L1/L2 was significantly lower than that of L3/L4 in all female patients, regardless of BMI group.
Conclusion: The BMDs of several body regions are associated with age and sex, with variations in the rate of change, age at first change, and age-related trends depending on the anatomical site and sex. Heterogeneity exists among the lumbar segments, as the BMDs of L1 and L2 are generally significantly lower than those of L3 and L4; however, this trend varies in specific subgroups.
Purpose: Combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries are common and present challenges in management. While ACL reconstruction has been established, the optimal approach for combined ACL and MCL injuries remains debatable owing to the varying severity and chronicity of MCL injuries. This study aimed to describe a novel surgical technique for chronic ACL and grade III MCL injuries and assess whether simultaneous ACL and MCL reconstruction improves chronic MCL instability.
Methods: A total of 41 patients diagnosed with combined ACL and MCL injuries were included in the study. Twenty-five patients were allocated into the simple ACL reconstruction (SAR) group while 16 patients were allocated into the simultaneous ACL and MCL reconstruction (SAMR) group according to MCL injury severity. The surgical technique utilized a single ipsilateral hamstring autograft for both ACL and MCL reconstruction. Clinical assessments, including range of motion (ROM), functional score, Lachman test, and valgus instability, were conducted before and after surgery. Postoperative magnetic resonance imaging (MRI) was used to evaluate graft quality.
Results: Postoperative outcomes revealed significant improvements in ROM, functional scores, Lachman test, and valgus instability in both groups. There were no significant differences between the SAR and SAMR groups, suggesting that patients with combined ACL rupture and severe MCL injuries can achieve similar stability outcomes as those with ACL rupture and mild MCL injuries. The MRI results revealed high-quality grafts in both groups.
Conclusion: This study introduces a novel technique using simple hamstring autografts for simultaneous ACL and MCL reconstruction, and this surgical technique can achieve knee stability comparable to that of low-grade MCL injuries and can be used for single ACL reconstruction. Further research with larger sample sizes and long-term follow-up is needed to confirm these findings.
Objective: Osteoarthritis (OA) is a progressive joint disease characterized by cartilage degradation driven by matrix-degrading enzymes. Reproducible ex vivo models are essential for studying early degenerative processes and evaluating potential therapeutics. However, there remains a lack of accessible, cost-effective models that accurately replicate the biochemical environment and early-stage damage of OA. This study aimed to develop and validate a bovine cartilage explant model that replicates key features of early OA through enzymatic induction of tissue damage.
Methods: Bovine stifle cartilage explants were exposed to combinations of matrix metalloproteinases, aggrecanases, and cartilage biomarkers. Tissue damage was evaluated histologically, and semiquantitative scoring was used to assess structural changes. Statistical analyses were conducted to determine differences between treatment groups.
Results: Enzyme-treated samples exhibited significantly greater cartilage degradation compared to controls. The addition of cartilage oligomeric matrix protein (COMP) increased tissue damage, suggesting an active role in matrix destabilization. In contrast, the inclusion of TIMP-3, a known protease inhibitor, did not reduce degradation, raising questions about its protective efficacy in this context.
Conclusion: This chemically induced bovine model successfully simulates early cartilage degeneration consistent with OA pathology. Supported by recent literature on the roles of MMPs, ADAMTS-5, and COMP in joint disease, the model offers a valuable platform for future studies on OA mechanisms and therapeutic screening.
Objectives: Obesity significantly influences the future of total knee arthroplasty (TKA). However, body mass index (BMI), the prevailing proxy for obesity, has limited predictive value for TKA outcomes, necessitating a more accurate obesity indicator. This study aimed to assess the utility of the fat-to-muscle ratio (FMR) in predicting postoperative outcomes related to obesity in patients undergoing TKA and compared its predictive value with that of BMI.
Methods: After excluding patients with secondary osteoarthritis, severe joint deformity, or neuromotor deficits, prospective data from 146 unilateral primary TKA patients were analyzed, including demographics, BMI, and systemic and leg-specific FMR. Primary outcomes included complications and 12-month patient-reported function (assessed using the University of California, Los Angeles [UCLA] activity scale and the Hospital for Special Surgery [HSS] score) and secondary outcomes including hospitalization length and surgery information were analyzed. Multivariable regression models were used to identify significant obesity-related predictors of outcomes, with linear regression employed for continuous outcomes (UCLA activity score, HSS score) and logistic regression for binary outcomes (complications).
Results: The mean BMI was 28.6 ± 4.4 kg/m2, systemic FMR 0.70 ± 0.23, and leg-specific FMR 0.62 ± 0.19. Both systemic FMR (OR 1.094, p = 0.036) and BMI (OR 1.050, p = 0.015) predicted systemic complications, with FMR explaining more variance (partial R2 = 0.134 vs. 0.088). Likewise, systemic FMR (RR, 0.950, p = 0.045; partial R2 = 0.227) and leg-specific FMR (RR, 0.922, p = 0.033; partial R2 = 0.344) showed stronger associations with HSS functional score, than BMI (RR, 0.974, p = 0.037; partial R2 = 0.118). Only leg-specific FMR predicted wound complications (OR 1.063, p = 0.024; partial R2 = 0.262), and HSS pain scores (RR = 0.923, p = 0.025; partial R2 = 0.077). Neither FMR nor BMI was correlated with surgical duration, hospitalization, activity, or ULCA activity scores (p > 0.05).
Conclusions: In this single-center study, FMR demonstrated statistically stronger associations than BMI with both perioperative complications and 12-month functional outcomes following TKA. FMR assessment may provide incremental value for preoperative risk stratification and functional outcome prediction in elective TKA.
Background: Osteonecrosis of the femoral head (ONFH) is a progressive and disabling disease that commonly affects young and middle-aged adults. Without timely treatment, it often progresses to femoral head collapse and hip dysfunction, ultimately requiring total hip arthroplasty. Although core decompression (CD) and superselective intra-arterial perfusion have been applied clinically, their long-term efficacy as monotherapy remains limited, and the clinical value of combining these approaches has not been fully clarified.
Objectives: This study aimed to evaluate the clinical efficacy of CD combined with superselective intra-arterial perfusion in the treatment of ONFH, and to identify key prognostic factors influencing therapeutic outcomes.
Methods: This study enrolled 145 patients in the CD group, 123 in the SIAE group, and 89 in the combined group. Preoperative baseline characteristics, postoperative Harris Hip Scores (HHS), Visual Analog Scale (VAS) scores, MRI-derived collapse rates, and complication rates were compared. Patients were stratified into effective and non-effective groups to analyze risk factors. Receiver operating characteristic (ROC) curves assessed predictive performance.
Results: Baseline characteristics, including sex, age, body mass index (BMI), Association Research Circulation Osseous (ARCO) staging, etiology, and lesion location, showed no intergroup differences. The combined group exhibited superior postoperative HHS improvement, VAS reduction, and collapse rate mitigation compared to monotherapy groups. Complication rates were lowest in the combined group (2.2%) versus CD (7.6%) and SIAE (12.2%) groups. The combined group had the highest efficacy rate, with non-traumatic etiology and marginal necrosis predominating in the effective group. Logistic regression identified surgical approach, BMI, etiology, and lesion location as independent predictors of efficacy. Surgical approach demonstrated the highest predictive power (area under the curve (AUC) = 0.7838, sensitivity 83.75%, specificity 60.41%), while the constant term achieved optimal performance (AUC = 0.8549).
Conclusion: CD combined with SIAE significantly enhances clinical outcomes, alleviates pain, reduces collapse rates, and minimizes complications in ONFH. Surgical approach, BMI, etiology, and lesion location critically influence efficacy. The combined strategy represents a superior intervention with promising clinical applicability.
Objectives: Ankle fracture with both deltoid ligament (DL) rupture and syndesmotic diastasis is often treated by syndesmotic fixation after fibular fixation. However, a second operation may be needed to remove the internal fixation, and screw breakage/misplacement may occur. The present study aimed to explore the mechanism and feasibility of DL augmentation instead of syndesmotic fixation from the perspective of biomechanics.
Methods: The CT data (in DICOM format) of a 33-year-old man were used to create a finite element model. External rotation stress and eversion stress were applied to the model, and the medial clear space (MCS) and tibiofibular clear space (TCS) were evaluated. In a separate experiment, preserved lower limb specimens were fixed on a hydraulic loading frame before undergoing DL augmentation and syndesmotic fixation in random order. A mechanical testing device was used to apply external rotation stress (4 N·m) and eversion stress (2.5 N·m) to the two groups (DL augmentation or syndesmotic fixation). The MCS and TCS were measured and compared between the two groups.
Results: In the finite element study, the MCS widening was lesser and the TCS widening was greater in the DL augmentation group than in the syndesmotic fixation group in both the external rotation and eversion tests. Nine specimens were analyzed in the biomechanical tests. There were no significant differences between the two groups in the widening of the TCS in the rotation tests (p = 0.093, Hodges–Lehmann median difference = −0.79, 95% confident interval: −1.70~0.27) and eversion tests (p = 0.237, HLD = −0.84, 95% CI: −2.57~1.09). However, the widening of the MCS was significantly lesser in the DL augmentation group than in the syndesmotic fixation group during the rotation tests (p = 0.036, HLD = 3.57, 95% CI: 0.40~6.41) and eversion tests (p = 0.018, HLD = 4.36, 95% CI: 1.84~7.35).
Conclusions: Compared with syndesmotic fixation, DL augmentation has better resistance to medial malleolar space widening under both external rotation and eversion forces and can restore the tibiofibular space to a certain extent. These results suggest that DL augmentation alone is a potential alternative to syndesmotic fixation for Weber-type C ankle fractures from a biomechanical point of view.
Objective: Early readmission following total hip arthroplasty (THA) is not uncommon and impacts patient outcomes and healthcare costs. However, easily accessible biomarkers for early identification of high-risk patients remain limited. This study aims to evaluate the association between various blood component-derived ratios and 14-day readmission after THA.
Methods: Data from the Chang Gung Medical Research Database (CGRD) from 2014 to 2022 were retrospectively analyzed. Patients ≥ 20 years old who underwent primary THA by a single surgeon were included. The primary outcome was 14-day readmission. Five hematologic markers were evaluated: monocyte-to-albumin ratio (MAR), red cell distribution width (RDW)-to-albumin ratio (RAR), hemoglobin-to-albumin ratio (HAR), leukocyte-to-albumin ratio (LAR), and RDW-to-platelet ratio (RPR). Ratios were calculated from blood collected within 1 month before to 1 week after surgery. Receiver operating characteristic (ROC) Curve analysis was used to determine their optimal thresholds, and multivariable logistic regression assessed associations between these markers and readmission risk.
Results: A total of 307 patients were included in the analysis. Among the ratios evaluated, only high RPR (≥ 0.10; aOR = 5.92, 95% CI: 2.19–16.00, p = 0.001) was significantly associated with increased risk of 14-day readmission after adjustment in the multivariable analysis.
Conclusion: RPR is independently associated with 14-day readmission following THA in this exploratory study. As an easily obtainable marker, it may aid postoperative risk stratification, and the findings provide a foundation for future multicenter prospective investigations incorporating more granular perioperative factors and additional biomarkers before clinical application.
Objective: The periprosthetic fractures occur frequently in modern society, and Vancouver type B fractures have the highest incidence. Surgical treatment of fractures was necessary; however, the traditional operations have obvious disadvantages. This study aimed to explore the clinical efficacy of a novel technique—minimally invasive percutaneous plate osteosynthesis (MIPPO) combined with noncontact bridging plate for periprosthetic fracture (NCB.PP) for treating Vancouver type B femoral periprosthetic fractures.
Methods: The clinical data of 24 patients with Vancouver type B femoral periprosthetic fractures who were admitted between October 2018 and January 2023 were retrospectively analyzed. Fourteen were male and 10 were female; the average age was 74.82 ± 12.11 years (range 65–93 years). All patients underwent biological hip arthroplasty, including 14 total hip replacements and 10 hemi-arthroplasties. All patients were injured by falls, and the average time from injury to hip replacement was 17.16 ± 7.17 months (range 7–34 months). According to Vancouver classification, 7, 14, and 3 patients were type B1, B2, and B3 fractures, respectively. Both MIPPO and NCB.PP were employed for fracture reduction and fixation for all patients. All patients were followed up for 18 months continuously. The operation duration, intraoperative blood loss, number of bicortical screws at the proximal end of the fracture, postoperative complications, fracture healing rate, and time of fractures were recorded for all the patients. The clinical efficacy was assessed using the Harris Hip Score.
Results: The average operation duration was 83.33 ± 12.16 min (range 60–150 min), the average intraoperative blood loss was 448.14 ± 186.24 mL (range 300–750 mL), and the average number of bicortical screws at the proximal end of the fracture was 3.62 ± 0.57 (range 3 ± 5). The fracture healing rate was 91.67%, and the average healing time was 7.83 ± 1.24 months (6–18 months). The average Harris Hip Score in the last follow-up was 73.75 ± 12.62 (range 45 ± 95). No cases of reduction loss, internal fixation failure, prosthesis dislocation, or renovation were reported. Two cases of superficial wound infection, three cases of postoperative pulmonary infection, and three cases of postoperative urinary tract infectionwere successfully treated with targeted interventions.
Conclusion: MIPPO combined with NCB.PP for treating Vancouver type B femoral periprosthetic fractures can shorten the operation duration, reduce intraoperative blood loss, alleviate iatrogenic surgical trauma, provide sufficient internal fixation strength, facilitate fracture healing, and stabilize the prosthesis effectively, and can be recommended for clinical use.
Background: Craniovertebral junction anomalies (CVJAs), including conditions such as basilar invagination and atlantoaxial dislocation, frequently result in progressive neurological deterioration. Traditional surgical approaches—whether anterior, posterior, or combined—may prove inadequate for revision cases characterized by persistent ventral compression. This study evaluates the efficacy of anterior transoral odontoid reduction combined with clivocervical fusion for managing complex CVJAs requiring revision surgery.
Methods: A 56-year-old female patient presented with recurrent symptoms following prior posterior occipitocervical fusion. She underwent revision surgery involving anterior transoral odontoid reduction combined with clivocervical fusion. Postoperative rehabilitation, imaging studies (CT, MRI, and CTA), and neurological function assessed via the JOA score were evaluated at 3-, 6-, and 12-month follow-up intervals.
Results: Postoperative imaging demonstrated significant improvements: the clivo-axial angle improved to 146.1° from 135.5°, the odontoid tip descended caudally by 4.33 mm, and spinal cord compression resolved. Neurological function improved, with stable fixation, successful fusion, and no complications. Long-term follow-up confirmed sustained radiographic stability and neurological recovery.
Conclusion: Anterior transoral odontoid reduction combined with clivocervical fusion effectively addresses persistent ventral compression in revision CVJAs cases. This technique achieves neural decompression, biomechanical stability, and functional recovery, offering a promising option for complex cases with failed initial posterior fixation.