Surgery continues to remain the most effective treatment for spinal metastasis (SM). As the number of surgeries continues to grow, the need for consensus guidelines for optimal perioperative care is imperative. Enhanced recovery after surgery (ERAS) protocols were created for this purpose. The objective of this study is to review evidence-based ERAS guidelines for SM surgery. A group of multiple experienced spine surgeons was invited to participate in this study. This group identified 19 ERAS items for SM surgery. The principal literature search utilized MEDLINE, Embase, and Cochrane databases to identify contributions related to the topic published. Systematic reviews, randomized controlled trials (RCTs), and observational cohort studies which reported SM surgery related to the ERAS topics were included. The evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendations were reached by the group after a critical appraisal of the literature. Five articles were included to develop the consensus statements for 19 ERAS items. All recommendations on ERAS protocol items are based on the best available evidence. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multimodal analgesic strategies. The level of evidence for the use of each recommendation is presented. Based on the best evidence available for each ERAS item within the multidisciplinary perioperative pathways, we presented this comprehensive consensus review for SM surgery. This ERAS elements can be implemented and practiced clinically.

Objective: At present, there is no clear clinical consensus on the optimal surgical method for the specific population of patients aged 60–70 years with unstable Pauwels Type III femoral neck fractures. Few studies have investigated the efficacy of the Femoral Neck System (FNS) in hip-preserving treatment for this patient group. Therefore, it is necessary to analyze the safety and efficacy of FNS in treating this population.

Methods: A retrospective analysis with pair matching of 93 patients who received FNS or total hip arthroplasty (THA) for Pauwels type III unstable femoral neck fracture in our hospital between January 2021 and August 2023 was conducted. This study used the inverse probability weighting (IPW) method to balance the baseline covariates between the THA group and the FNS group. The effect of covariate balance was evaluated by calculating the standardized mean difference (SMD). The operation duration, intraoperative blood loss, time to begin weight-bearing, Harris score, and complication rate were compared between the two groups. For Harris hip score, generalized estimation equations (GEE) were used. For continuous outcomes, weighted linear regression was used. All statistical analyses report estimates, standard errors, test statistics, p-values, and 95% confidence intervals (CI), with p < 0.05 indicating statistically significant differences.

Results: After inverse probability weighting (IPW), the standardized mean difference (SMD) of all covariates was < 0.1, indicating well-balanced baseline covariates between groups and effective reduction of confounding bias. The THA group had significantly longer operation duration (119.23 ± 4.62 min vs. 69.61 ± 2.23 min; between-group difference: −49.62 min, 95% CI: −59.51~−39.73 min, p < 0.05) and greater intraoperative blood loss (205.20 ± 8.60 mL vs. 80.99 ± 7.36 mL; between-group difference: −124.22 mL, 95% CI: −146.62~−101.82 mL, p < 0.05) than the FNS group, but significantly shorter time to begin weight-bearing (3.12 ± 0.15 d vs. 73.38 ± 1.04 d; between-group difference: 70.26 d, 95% CI: 68.19~72.34 d, p < 0.05). During follow-up, HSS scores increased over time in both groups, but the between-group difference trend varied. Complication rate was 6.5% in THA group vs. 8.5% in FNS group; relative risk: 3.709 (95% CI: 0.53~26.08, p = 0.1877), with no statistical significance.

Conclusion: For the treatment of Pauwels type III unstable femoral neck fractures in elderly patients aged 60–70 years, FNS can achieve satisfactory joint range of motion and clinical efficacy. Compared with THA, FNS can preserve the normal anatomical structure of the hip joint and has less blood loss and shorter operation time.

Background: Acetabular fractures in children are extremely rare, accounting for approximately 1%–4.6% of all pediatric fractures. Due to their rarity, literature on these injuries is limited, with only a few reported cases. The primary objective of this study was to present a series of uncommon pediatric injuries, outline our management approach, and demonstrate that even patients undergoing delayed surgical intervention can achieve favorable clinical outcomes.

Materials and Methods: This retrospective study reviewed records of skeletally immature patients with traumatic acetabular fractures treated at our institution. Patients were surgically treated with open reduction and internal fixation through lateral rectus abdominis approach; follow-ups included radiological assessment of bone union and internal fixation integrity. Postoperative reduction was evaluated using Matta's criteria, while functional outcomes were measured via the Modified Merle d'Aubigné and Postel Method (pain, gait, mobility) and the Harris Hip Score (HHS). Complications were documented throughout follow-up.

Results: Between January 2019 and January 2025, 14 pediatric patients with acetabular fractures (five males, nine females; mean age 11.42 ± 2.24 years) were treated and followed for an average of 33.71 ± 14.41 months. Injuries resulted from falls (57.14%), car accidents (28.57%), and motorcycle/bicycle accidents (7.14% each). According to Judet and Letournel classification, fractures included double-column (57.14%), transverse (35.72%), and anterior with posterior hemi-transverse (7.14%). All underwent surgery, achieving bone union. The mean Harris Hip Score was 90.35 ± 5.58, with 71.42% rated excellent, 21.42% good, and 7.14% fair. The mean Merle d'Aubigné score was 17.21 ± 1.12. Mild hip pain occurred in three patients, with no other complications.

Conclusion: Pediatric acetabular fractures, typically caused by high-energy trauma, require treatment focused on optimal outcomes and anatomical reduction, even in delayed cases. This study shows that, in specialized centers, experienced surgical teams can achieve successful reduction and satisfactory results despite delayed intervention.

Objective: Lumbar fusion surgery is a significant surgical approach for degenerative lumbar spine diseases. However, lumbar fusion can cause adjacent vertebral diseases, about 50% of which is spinal stenosis. Unilateral laminectomy is an effective treatment for lumbar spinal stenosis. Therefore, this study aims to assess whether concurrent unilateral laminotomy decompression of the proximal adjacent vertebrae during primary lumbar fusion reduces long-term adjacent spinal stenosis incidence.

Methods: Patients (n = 179) who underwent lumbar fusion surgery between January 2021 and June 2023 were included in this retrospective analysis. A total of 110 patients underwent single-segment lumbar fusion surgery, including 28 (A1) in the adjacent vertebral decompression group and 82 (B1) in the non-decompression group. The mean follow-up duration was 11.74 ± 4.64 months for group A1 and 12.01 ± 4.83 months for group B1. 69 patients underwent two-segment lumbar fusion surgery, including 28 (A2) in the adjacent vertebral decompression group and 41 (B2) in the non-decompression group. The mean follow-up duration was 12.49 ± 4.57 months for group A2 and 12.12 ± 5.97 months for group B2. The visual analog scale (VAS) score, Oswestry disability index (ODI), and dural sac cross-sectional area (DSCA) were used to evaluate clinical outcomes. Operation time, blood loss, and complications were recorded. All continuous variables with normal distribution were analyzed using the t-test, while count data were compared using the chi-square test or Fisher's exact test.

Results: After surgery, the DSCA of the adjacent vertebral canal in the adjacent vertebral decompression group was significantly increased (A1: 111.64 ± 24.45 vs. 135.69 ± 35.46 mm², p < 0.001; A2: 99.95 mm² ± 16.81 vs. 115.29 ± 21.19 mm², p < 0.001). The DSCA of the adjacent vertebral canal in the non-decompression group was significantly decreased (B1: 114.38 ± 28.83 vs. 111.41 ± 30.73 mm², p = 0.032; B2: 109.28 ± 23.39 mm²vs. 102.04 ± 25.52 mm², p = 0.001). There was no significant difference between the decompression and non-decompression group in preoperative pain scores (A1 vs. B1: 5.29 ± 1.41 vs. 5.42 ± 1.31, p = 0.661; A2 vs. B2: 6.07 ± 1.78 vs. 5.88 ± 1.81, p = 0.662), ODI (A1 vs. B1: 57.07 ± 15.73 vs. 55.44 ± 12.49, p = 0.578; A2 vs. B2: 62.07 ± 14.86 vs. 59.46 ± 16.69, p = 0.508) and postoperative pain scores (A1 vs. B1:0.93 ± 0.94 vs. 1.22 ± 0.96, p = 0.166; A2 vs. B2: 1.21 ± 1.07 vs. 1.46 ± 0.95, p = 0.313), ODI (A1 vs. B1: 7.14 ± 4.40 vs. 8.05 ± 5.03, p = 0.398; A2 vs. B2:7.71 ± 5.62 vs. 9.12 ± 6.28, p = 0.344). The difference in complication incidence was not significant.

Conclusions: These results showed that decompression of adjacent spine would maintain the spinal canal after lumbar fusion surgery.

Objective: Insufficient correction of segmental lordosis is an important risk factor for adjacent segment disease (ASD). This study aimed to investigate the relationship between segmental lordosis–related parameters and ASD following lumbar facet joint fusion (FJF).

Methods: A retrospective analysis was conducted on 29 patients who underwent revision surgery for ASD after posterior lumbar fusion at our institution between February 2014 and February 2024. A matched control group of 29 non-ASD patients was selected based on age at initial surgery, sex, fusion level, and follow-up duration. Preoperative, postoperative, and final follow-up lumbar radiographs were analyzed. Parameters assessed included lumbar lordosis (LL), segmental lordosis (SL), sacral slope (SS), and relative disc height of adjacent segments. General baseline characteristics, sagittal parameters before and after the initial surgery, and correction values of sagittal alignment were compared between the two groups. Parameters showing significant differences were further analyzed using binary logistic regression, and receiver operating characteristic (ROC) curves were used to determine predictive thresholds of independent risk factors for ASD.

Results: There were no significant differences in baseline characteristics between the two groups (p > 0.05). After the primary fusion surgery, LL and SS were significantly lower in the ASD group compared with the control group (p < 0.05). Regarding sagittal correction, the relative change in SL (r△SL) was significantly smaller in the ASD group (p < 0.05), confirming insufficient local curvature reconstruction. Logistic regression identified r△SL as an independent risk factor for ASD (p = 0.004, OR = 0.976, 95% CI: 0.960–0.992). ROC curve analysis revealed an area under the curve (AUC) of 0.712 (95% CI: 0.580–0.844), with an optimal predictive threshold of 2.6% for r△SL.

Conclusion: Insufficient correction of segmental lordosis is a key risk factor for ASD following lumbar facet joint fusion, and prioritizing the restoration of local sagittal alignment during surgery may effectively reduce the incidence of postoperative ASD.

Objective: Although advances in disease-modifying therapies have improved rheumatoid arthritis (RA) management, many patients still require total hip or knee arthroplasty. Long-term data on baseline characteristics and treatment patterns of RA patients undergoing arthroplasty in China are scarce. This study aimed to investigate time trends in baseline demographic, clinical, laboratory, and treatment parameters of RA patients undergoing THA and TKA between 2002 and 2022.

Methods: A retrospective study of consecutive THAs and TKAs for RA patients between 2002 and 2022 was conducted at a single center. The preoperative patient demographics, clinical and laboratory parameters were collected. All joints were divided into 2002–2011 and 2012–2022 groups, THA and TKA groups, juvenile-onset rheumatoid arthritis (JORA) (0–16 years), adult-onset rheumatoid arthritis (AORA) (16–60 years), and late-onset rheumatoid arthritis (LORA) (≥ 60 years) groups, respectively. The intergroup comparisons were performed.

Results: A total of 1363 primary TKAs in 897 patients with RA and 561 hips in 511 patients with RA were included. The number of arthroplasties performed annually from 2002 to 2022 demonstrated a significantly increasing trend. The use of glucocorticoids (GCs) before surgery demonstrated a significant decreasing trend while conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs) + targeted synthetic DMARDs (tsDMARDs) demonstrated an increasing trend. Comparison by time period (2002–2011 vs. 2012–2022) showed that the percentage of preoperative use of csDMARDs and bDMARDs + tsDMARDs was significantly higher and GCs were significantly higher in the 2002–2011 group.

Conclusions: The number of THAs and TKAs performed annually from 2002 to 2022 demonstrated a significantly increasing trend in a tertiary care center for musculoskeletal diseases. In contrast, a significantly increasing trend for the percentage of preoperative use of csDMARDs and bDMARDs + tsDMARDs and a significantly decreasing trend for preoperative use of GCs and inflammatory markers was identified.

Background: Symptomatic pseudomeningocele (PMC) causing spinal cord compression is a severe complication following spinal surgery. Traditional management remains controversial, with surgical revision carrying significant risks. This study evaluates an innovative minimally invasive approach using central venous catheterization for percutaneous PMC drainage.

Case Presentation: A multicenter case series included 17 patients with thoracic ossifying disease who developed PMC with neurological deterioration postoperatively. Under B-ultrasound guidance, an experienced spinal surgeon performed percutaneous puncture and drainage of the PMC using a central venous catheter system. All patients achieved complete PMC drainage confirmed by MRI, with resolution of spinal cord compression.

Conclusion: Ultrasound-guided central venous catheter drainage is a safe, effective, and minimally invasive alternative for managing PMC-induced spinal cord compression. This technique achieves rapid symptomatic relief, neurological recovery, and durable results without recurrence. Its successful extension to postoperative pseudocyst/abscess drainage suggests broad applicability in spinal complications.

Objectives: Total hip arthroplasty (THA) is the gold standard for treating Crowe IV developmental dysplasia of the hip (DDH). However, its long-term effects on lower limb alignment, gait biomechanics, and plantar force in these patients remain underexplored, which is discussed in this article.

Methods: We conducted a retrospective cohort study that included 43 DDH Crowe IV patients who underwent THA between February 2008 and October 2019 and a control group of 43 matched healthy volunteers. Postoperative functional outcomes and quality of life were assessed using the Harris Hip Score, KOOS, AOFAS, and WOMAC scores. Lower limb alignment parameters (MAD, HKA, aTFA, mLDFA, mMPTA, and FO), knee alignment (HMFC, HLFC), and ankle alignment (mLDTA, FACO, and TT) were measured preoperatively, postoperatively, and at follow-up. Gait analysis and plantar force measurements were performed at the final follow-up.

Results: With an average follow-up of 10.2 years, patients showed significant improvement in functional and quality of life scores compared to pre-surgery. Preoperatively, all patients had knee valgus and ankle varus on the affected side. After THA, most parameters showed reduced valgus alignment, except for HKA and HLFC. On the unaffected side, MAD, aTFA, and HKA indicated preoperative valgus, which was fully corrected post-THA. Gait analysis revealed restricted lower limb motion and abnormal plantar force distribution that persisted postoperatively in Crowe IV DDH patients.

Conclusions: THA partially corrected abnormal lower limb alignment, gait parameters, and plantar force distribution in DDH Crowe IV patients over long-term follow-up.

Purpose: Open-wedge high tibial osteotomy (OWHTO) is established for young, active patients with medial knee osteoarthritis. Patient-specific 3D-printed guide plates have been introduced to improve surgical precision and efficiency, but evidence of clinical and economic benefit is limited. We aimed to determine whether a 3D-printed patient-specific guide plate improves efficiency, functional outcomes, and cost-effectiveness compared to standard OWHTO.

Methods: In this multicenter randomized trial, patients scheduled for OWHTO were allocated to either conventional planning (control) or surgery using a patient-specific 3D-printed guide plate between November 2020 and June 2024. The primary endpoint was the 12-month Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score. Secondary outcomes included knee range of motion (flexion in degrees), 30-s chair-stand test (number of stands), operative time, and health economic measures (direct costs and quality-adjusted life years). Analyses were by intention-to-treat using appropriate statistical tests.

Results: A total of 180 patients (mean age 55 years, 56.7% male) were randomized equally between groups. At 12 months, mean WOMAC pain was 15.2 (SD 8.4) in the guide-plate group and 15.6 (SD 8.7) in controls, with no significant difference (p = 0.74). The guide-plate group showed significantly greater knee flexion (mean 128° vs. 122°; p = 0.04) and a higher 30-s chair-stand count (14.2 vs. 12.5 stands; p = 0.02) than controls. There were no other significant between-group differences in clinical scores. Mean total cost per patient was not statistically significant in the ITT analysis (p = 0.094). Quality-adjusted life years did not differ between groups, yielding no cost-effectiveness advantage. These findings echo prior reports that OWHTO techniques with higher costs have similar patient outcomes.

Conclusion: Using a 3D-printed patient-specific guide plate did not improve the primary pain outcome or overall functional outcome compared to standard OWHTO. It yielded minor gains in knee flexion and chair-stand performance, but at greater cost. No overall cost-effectiveness benefit was observed. Routine use of this technology for OWHTO is not supported by our findings.

Level of Evidence: Level I, randomized controlled trial.

Trial Registration: Chinese Clinical Trial Registry (https://www.chictr.org.cn/): ChiCTR2000038619

Objective: Cage subsidence following anterior cervical discectomy and fusion (ACDF) is linked with poor bone quality. MRI-derived bone quality scores have been shown to provide valuable insights into postoperative complication risk; however, the optimal MRI-based metric for predicting cage subsidence remains unclear. This study aims to compare the predictive value of different MRI-derived bone quality measures for cage subsidence following ACDF.

Methods: Patients undergoing single-level ACDF between October 2012 and September 2022 at our institution with at least 6 months of radiographic follow-up were retrospectively evaluated. T1 preoperative MRI scans were used to measure mean, median, and segmental vertebral bone quality (VBQ) scores, and upper, lower, and average endplate bone quality (EBQ) scores. Postoperative and follow-up X-rays were used to identify cage subsidence.

Results: Fifty-six patients met the inclusion criteria; 26 developed cage subsidence and 30 did not. Age, sex, surgical indication, cage type, and clinical setting were similar between groups. Mean disc space loss was significantly greater in the subsidence group (3.99 mm vs. 0.37 mm; p < 0.001). All bone quality scores were significantly higher in the subsidence group across all metrics. Mean VBQ (OR = 14.22), segmental VBQ (OR = 8.23), and lower EBQ (OR = 5.54) were strong predictors of subsidence (p < 0.001). ROC analysis showed excellent discrimination for mean VBQ (AUC = 0.821), segmental VBQ (AUC = 0.817), and median VBQ (AUC = 0.817). Interobserver reliability was high for all bone quality metrics (ICC 0.836–0.925).

Conclusion: MRI-derived bone quality metrics, particularly VBQ and lower endplate EBQ scores, are strong predictors of cage subsidence following single-level ACDF. These findings reinforce the clinical utility of preoperative MRI as a non-invasive, radiation-free tool for assessing vertebral bone integrity. Incorporating VBQ and EBQ assessments into surgical planning may enhance risk stratification and optimize postoperative outcomes in patients undergoing cervical fusion.

Objective: A comprehensive understanding of the anatomical structure of the femur is crucial for optimizing surgical approaches and improving prosthesis design. This study aims to conduct a thorough analysis of the anatomical structure of the Chinese femur using statistical shape models (SSM), thereby providing scientific evidence for clinical applications.

Method: In this study, the femoral CT data of 209 Chinese patients were collected for detailed 3D reconstruction to obtain a 3D model of the bilateral femur. Advanced 3D model alignment techniques and dense homologous mesh mapping methods were used to ensure the high accuracy and consistency of the models. Three-dimensional statistical shape modeling (SSM) and principal component analysis (PCA) methods were used to extract the main patterns of femoral morphology changes and further analyze the femoral morphology changes. On this basis, the effects of gender differences on femur morphology were further comparatively analyzed.

Results: This study successfully established a statistical shape model of the femur in the Chinese population and extracted patterns of femoral shape variation through principal component analysis. The first six principal components shape change patterns accounted for 82.7%, 3.4%, 2.7%, 2.5%, 2.0%, and 1.5% of the total change, respectively. The model of variation for each of the first six principal components accounted for more than 1% of the total anatomical variance and together explained 94.8% of the variance. PC01, PC02, PC03, PC04, and PC06 exhibited significant differences between sexes (p < 0.05).

Conclusion: By constructing a three-dimensional statistical shape model of the femur, this study reveals individual morphological variations as well as differences based on sex. This model not only deepens the understanding of the anatomical morphology of the Chinese femur but also provides an important scientific basis for the optimization of clinical surgical plans and the improvement of prosthesis design.

Objective: Adolescent idiopathic scoliosis (AIS) necessitates multimodal management strategies integrating orthotic intervention and physiotherapeutic scoliosis-specific exercises (PSSE). This study aimed to compare the clinical efficacy of brace therapy combined with tele-rehabilitation-guided PSSE versus brace treatment with self-guided home-based PSSE in mitigating spinal deformity progression.

Methods: A cohort of 67 treatment-naïve AIS patients from a tertiary scoliosis center (July 2021–July 2023) was stratified into two intervention groups: (1) tele-rehabilitation (real-time digitally supervised PSSE) and (2) autonomous practice (self-guided home PSSE). Longitudinal evaluations at baseline, 6, 12, and 24-month intervals included radiographic Cobb angle quantification, scoliometric angle of trunk rotation (ATR) assessment, and Scoliosis Research Society-22 (SRS-22) patient-reported outcomes. Treatment success was categorized as improvement (Cobb reduction ≥ 5°), stability (change < 5°), or progression (increase ≥ 5°). Data were analyzed using paired and independent t-tests, Mann–Whitney U test, and Pearson's χ² test.

Results: At 24-month follow-up, the tele-rehabilitation group exhibited significantly higher Cobb angle improvement rates (70.6% vs. 57.6%, p < 0.05) and lower progression rates (2.9% vs. 6.1%) compared to the autonomous practice group. Axial rotation correction demonstrated superior outcomes in the supervised cohort (final ATR: 6.9° ± 1.9° vs. baseline, p < 0.01). All SRS-22 domains showed clinically meaningful improvements (p < 0.05).

Conclusion: Tele-rehabilitation-guided PSSE combined with bracing demonstrates enhanced efficacy over self-guided protocols in achieving three-dimensional deformity correction, stabilizing curve progression, and optimizing patient-centered outcomes. Structured digital supervision emerges as a critical adjunct to orthotic management, advocating for technology-integrated conservative strategies in adolescent spinal deformity care.

Objective: Percutaneous vertebroplasty (PVP) is a commonly used minimally invasive procedure in thoracolumbar osteoporotic vertebral compression fractures (OVCFs) patients. At present, there are no relevant studies on the effects of PVP on the occurrence of adjacent intervertebral bridging ossification.

Methods: We reviewed clinical data of patients with thoracolumbar OVCFs treated in our hospital between January 2018 and December 2022. Patients were divided into bridging ossification and non-bridging ossification groups according to whether or not intervertebral bridging ossification had occurred. The clinical data collected included whether PVP surgery was performed, age, sex, body mass index, Hounsfield unit value, bone metabolism indexes, endplate fracture types, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, local kyphosis, Gardner angle, Cobb angle, the ratio of posterior border height (PBH) to anterior border height (ABH), and Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores. We investigated the differences in these parameters and analyzed their relationship with intervertebral bridging ossification.

Results: A total of 183 eligible patients were included in the study. The highest rate of intervertebral bridging ossification was observed at T12 level (55.7%). Ninety patients developed adjacent intervertebral bridging ossification (63 patients received conservative treatment and 27 patients underwent PVP surgery). The rate of intervertebral bridging ossification reduced in PVP patients (p < 0.001). There were significant differences in age, HU value, local kyphosis, Gardner angle and PBH/ABH between the bridging and non-bridging groups (p < 0.05). At 12 months post-treatment, there were no significant differences in VAS and ODI scores between patients with bridging ossification in the conservative treatment group and those in the PVP group (p > 0.05). Conservatively managed patients who developed intervertebral bridging ossification had significantly better VAS and ODI scores than those who did not (p < 0.05).

Conclusions: PVP reduced the adjacent intervertebral bridging ossification rates in thoracolumbar OVCFs patients. This may be related to the improvement in local mechanical stability. Other influencing factors included age, Hounsfield unit value, Gardner angle, local kyphosis, and PBH/ABH.

Objective: The global aging population has led to a significant increase in hip fractures among elderly patients, posing substantial clinical challenges. While early surgical intervention is widely advocated, its impact on postoperative complications and mortality in super-aged (≥ 80 years) hip fracture patients remains controversial. This study aimed to evaluate the association between early surgery and clinical outcomes in this population.

Methods: We conducted a retrospective cohort study of patients aged ≥ 80 years who underwent hip fracture surgery at a single-center orthopedic trauma center between January 2018 and November 2021. Participants were stratified into early surgery (≤ 48 h post-admission) and non-early surgery groups. Propensity score matching (PSM) was employed to control for confounding variables. Primary outcomes included 30-day, 90-day, 1-year, and 2-year mortality rates. Secondary outcomes encompassed perioperative transfusion rates, postoperative complications, hospital length of stay (LOS), and hospitalization costs.

Results: After PSM, a total of 300 patients were included. Compared with the non-early surgery group, the early surgery group had lower 1-year (11.6% vs. 28.0%, p < 0.001) and 2-year (36.0% vs. 50.7%, p = 0.010) postoperative mortality rates, a lower perioperative blood transfusion rate (32.7% vs. 53.3%, p < 0.001), lower incidences of postoperative pneumonia (15.3% vs. 29.3%, p = 0.004) and delirium (14.0% vs. 36.0%, p < 0.001), a shorter length of stay [8.6 days (7.5, 11.2) vs. 11.6 days (9.7, 14.9), p < 0.001], and lower hospitalization expenses [54,336 ¥ (48,965, 64,532) vs. 61,616 ¥ (50,758, 74,484), p = 0.001]. The serum albumin level at discharge in the early surgery group was higher (33.4 (31.6, 35.4) vs. 32.6 (30.7, 34.9), p = 0.039). Kaplan–Meier survival curve analysis showed that the all-cause mortality rate in the non-early surgery group increased (Log Rank p = 0.0066). Multivariate Cox analysis showed that age, BMI, admission hemoglobin, and non-early surgery were risk factors for 2-year mortality.

Conclusion: Early surgical intervention for hip fractures in super-aged patients is associated with improved survival, reduced complications, and better resource utilization. These findings support the implementation of protocols to minimize preoperative delays in this vulnerable population.

Background: Robotic-assisted technology has increasingly been applied in orthopedic surgery; however, its safety and efficacy in the treatment of scaphoid fractures remain controversial and lack high-level evidence. This systematic review and meta-analysis aimed to compare robotic-assisted techniques with conventional fluoroscopy-guided techniques in the treatment of scaphoid fractures.

Methods: A systematic literature search was conducted in PubMed, CNKI, VIP, Cochrane Library, Web of Science, and Scopus. Randomized controlled trials and cohort studies comparing robotic-assisted and conventional fluoroscopy-guided screw fixation for scaphoid fractures were included. Primary outcomes included operative time, fluoroscopy frequency, frequency of guidewire adjustments, intraoperative blood loss, fracture healing time, postoperative Visual Analog Scale (VAS), Mayo functional score, and complication rates. Meta-analysis was performed using Review Manager 5.4.

Results: Compared with conventional fluoroscopy-guided techniques, robotic-assisted technology significantly reduced operative time, fluoroscopy frequency, frequency of guidewire adjustments, intraoperative blood loss, and fracture healing time (all p < 0.05). In addition, the Mayo functional score was significantly higher in the robotic-assisted group (p < 0.05). No statistically significant differences were observed between the two groups in postoperative VAS scores or complication rates (p > 0.05).

Conclusions: Robotic-assisted technology demonstrates superior safety and efficacy compared with conventional fluoroscopy-guided techniques in the treatment of scaphoid fractures. It offers advantages in surgical efficiency, radiation reduction, fracture healing, and functional recovery, supporting its clinical application.

Objective: Posteriorly tilted femoral neck fractures have been extensively studied, whereas anteriorly tilted fractures remain largely unreported. This study aims to characterize the clinical features, radiographic patterns, and postoperative outcomes of femoral neck fractures with anterior tilt.

Methods: This retrospective cohort study included adult patients with OTA/AO type 31B femoral neck fractures who underwent internal fixation within 36 h at a single orthopedic center from 2018 to 2022 and had ≥ 24 months of follow-up. Tilt angle was assessed using preoperative radiographs and CT. Associations between fracture characteristics and postoperative outcomes were examined using univariate and multivariable logistic regression, with covariates selected according to clinical relevance and univariate significance.

Results: Among 212 patients (median age: 55 years, 53.3% male), anterior tilt fractures were more common in females (57.6%) and those with valgus malalignment (69.7%). Anteriorly tilted femoral neck fractures required a distinct reduction technique compared to conventional femoral neck fractures. Displaced fractures were significantly associated with a higher risk of femoral head necrosis (adjusted odds ratio [aOR] = 4.16; 95% confidence interval [CI] 1.29–13.42; p = 0.017). Stratified analysis revealed that anteriorly tilted femoral neck fractures with varus malalignment—herein referred to as the “anterior-flexion/adduction” subtype—were significantly associated with increased risk of femoral head necrosis (aOR = 7.19; 95% CI 1.12–46.18; p = 0.038).

Conclusions: Anterior tilt alone is not a general prognostic risk factor; however, fractures characterized by anterior tilt combined with varus alignment represent a high-risk subtype requiring careful preoperative recognition and treatment planning. Further prospective studies are needed to validate these findings.

Objective: Postoperative loss of cervical lordosis remains a common and clinically relevant complication following laminoplasty, negatively affecting neck pain, neurological recovery, and long-term sagittal balance. However, reliable and easily applicable preoperative predictors for identifying patients at high risk of cervical lordosis deterioration remain limited. This study aims to investigate whether preoperative C2 slope (C2S) independently predicts cervical lordosis deterioration following laminoplasty.

Methods: This retrospective cohort study included 179 patients who underwent cervical laminoplasty for cervical spondylotic myelopathy at our institution between April 2014 and December 2020, with a minimum follow-up of 24 months. Radiological parameters including C2-7 Cobb angle, cervical sagittal vertical axis (cSVA), C7 slope, and C2S are measured preoperatively and at final follow-up. Patients are divided into lordosis deterioration group (> 5°) and control group (≤ 5°). B Between-group comparisons are performed using independent-samples t tests and χ² tests. Binary logistic regression analysis is conducted to identify independent predictors of postoperative cervical lordosis loss. Receiver operating characteristic (ROC) curve analysis is used to evaluate predictive performance and determine the optimal cutoff value.

Results: The lordosis loss group (n = 55) shows significantly higher preoperative C2S (14.57° ± 3.47° vs. 9.52° ± 7.30°, p < 0.001), lower preoperative Cobb angle (13.01° ± 4.91° vs. 16.1° ± 6.50°, p < 0.001), and greater cSVA (2.58 ± 1.45 cm vs. 2.13 ± 1.42 cm, p = 0.027) compared to controls. The lordosis loss group demonstrates worse postoperative neck pain VAS scores (3.31 ± 1.63 vs. 2.40 ± 1.56, p < 0.001) and slightly lower JOA scores (15.45 ± 1.14 vs. 15.78 ± 1.12, p = 0.037). Multivariate analysis reveals preoperative C2S as the only independent predictor (OR = 1.176, p < 0.001), with 11.49 as cutoff value for C2S.

Conclusion: Elevated preoperative C2S independently predicts postoperative cervical lordosis deterioration. C2S measurement provides a simple, effective tool for identifying high-risk patients and optimizing surgical planning.

Background: Identifying predictors of perioperative blood transfusion is essential for optimizing patient safety and perioperative blood management in total hip arthroplasty (THA). This Study aimed to identify perioperative factors independently associated with transfusion.

Methods: This retrospective study included all elective primary THA procedures performed between 2016 and 2023 at a certified Endoprosthetic Center. Demographic, clinical, laboratory, and operative variables were extracted. Total and hidden blood loss were calculated using the Nadler and Gross/Sehat formulas. A multivariable logistic regression model was fitted to identify independent factors associated with transfusion. Receiver operating characteristic (ROC) analyzes were performed for cup inclination and the 48-h hematocrit. Cutoff thresholds were derived using Youden's index, and combined decision rules (AND/OR) were evaluated.

Results: Among 39 predictors, three variables were independently associated with transfusion: cup inclination (OR = 0.89; p = 0.0003), 48-h hematocrit (OR ≈5.17 × 10⁻⁴⁸; p = 0.023), reflecting quasi-separation due to a near-deterministic threshold effect rather than a literal effect size, and reoperation (OR = 13.19; p = 0.049). The model demonstrated excellent discrimination (AUC = 0.931). Inclination alone showed negligible predictive value (AUC = 0.393). The 48-h hematocrit was a strong single predictor (AUC = 0.817) with a clinically meaningful threshold (< 0.28 L/L). Combined rules showed moderate performance; the OR rule was ineffective.

Conclusion: Early postoperative hematocrit is a robust and clinically actionable marker associated with transfusion risk in primary THA. Cup inclination reflects the surgical technique rather than direct transfusion risk, and reoperation likely indicates underlying perioperative complexity. Transfusion strategies should prioritize hematocrit-based evaluation rather than inclination-based thresholds.

Level of Evidence: III—retrospective single-center observational cohort study.

Purpose: Posterior endoscopic surgery has become a mainstream minimally invasive approach for the treatment of cervical spondylotic radiculopathy (CSR). Arthroscopic-assisted uni-portal spine surgery (AUSS), an emerging technique, has demonstrated favorable clinical outcomes in lumbar spine surgery; however, its feasibility and effectiveness in cervical spine surgery have not yet been reported. Accordingly, this technical note aimed to describe the surgical technique of AUSS combined with Kirschner wire anchoring for the treatment of CSR and to evaluate its preliminary clinical outcomes.

Methods: Fifteen consecutive CSR patients (9 males, 6 females) underwent AUSS combined with Kirschner wire anchoring between February and October 2024. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for neck and arm pain, the Neck Disability Index (NDI), and the modified MacNab criteria. Pre- and postoperative pain and functional scores were compared using a paired t-test, with effect sizes (Cohen's d) and 95% confidence intervals (CIs) for mean differences calculated. Radiological parameters included osteotomy area and facet joint resection rate.

Results: All procedures were successfully completed with a mean operative time of 97.7 ± 18.2 min and a mean incision length of 1.7 ± 0.2 cm. Postoperatively, VAS score for arm improved from 6.5 ± 0.9 to 2.8 ± 0.7 (p < 0.05), VAS score for neck from 4.3 ± 1.9 to 2.7 ± 1.0 (p < 0.05), and NDI from 54.3 ± 6.7 to 9.7 ± 2.4 (p < 0.05). The mean osteotomy area measured 98.6 ± 12.1 mm², with a facet joint removal rate of 27.6% ± 8.6%. At the 6-month follow-up, 86.7% (13/15) of patients achieved excellent/good outcomes. No serious surgery-related complications were observed.

Conclusion: The AUSS with Kirschner wire anchoring achieved significant pain relief and functional improvement in CSR, demonstrating feasibility and safety in the short term. However, larger cohorts and long-term studies are required to validate its efficacy.