Inflammatory pseudotumor (IP) is an increasingly recognized etiological factor in the failure of total hip arthroplasty (THA). It is a non-neoplastic, non-infectious mass encircling a hip prosthesis following arthroplasty and may appear as cystic, solid, or mixed tissue. Although initially associated with metal-on-metal (MoM) bearing surfaces, IP formation can also occur with other bearing types. Recognized risk factors include female sex, specific genetic predispositions, MoM bearings, large femoral head size, modular femoral stem designs, elevated metal ion levels, and wear debris from polyethylene components. IP contributes to THA failure through both mechanical and inflammatory mechanisms, often leading to pain, instability, or implant loosening. Diagnosis relies heavily on imaging modalities, including plain radiographs, ultrasound, CT, and MRI with metal artifact reduction sequences (MARS-MRI), which help delineate the extent and characteristics of IP lesions. A multimodal imaging approach is essential for accurate assessment and surgical planning. Management strategies are guided by clinical presentation and radiographic findings, such as IP size and anatomical location, ranging from close observation in asymptomatic cases to revision surgery in symptomatic or progressive disease. IP is therefore an important, imaging-detectable cause of THA failure, and awareness of its presentation and diagnostic features is critical for timely intervention and improved patient outcomes.

Objective: Spinal muscular atrophy (SMA) is a rare neuromuscular disorder frequently associated with progressive scoliosis, often requiring complex surgical intervention. Perioperative management for SMA patients remains challenging due to severe respiratory compromise, difficult airway anatomy, and a high risk of perioperative complications. This study aimed to analyze perioperative strategies and outcomes in SMA patients undergoing posterior spinal fusion for scoliosis correction.

Methods: We retrospectively reviewed SMA patients who underwent posterior spinal fusion at our institution from January 2018 to December 2024. Primary outcomes included intraoperative blood loss, postoperative complications, and perioperative hypokalemia; secondary outcomes included postoperative mechanical ventilation duration, length of stay in the ICU and hospital, and radiographic outcomes. Subgroup comparisons between SMA type 2 and type 3 were performed using the independent-samples t-test or Mann–Whitney U test for continuous variables and the chi-square test or Fisher's exact test for categorical variables.

Results: Forty-three SMA patients (72.1% type 2, 27.9% type 3) with a mean age of 15.9 ± 4.9 years were included. Spinal deformity was severe, with a mean preoperative Cobb angle of 113.2° ± 22.8°. Pulmonary function was markedly impaired, with a median forced vital capacity (FVC) of 34.8% (IQR: 24.6%–46.4%) of the predicted value. Endotracheal intubation was challenging, with 93.0% (n = 40) requiring video laryngoscopy or awake tracheal intubation using flexible bronchoscopy. Blood loss was substantial, with a median intraoperative blood loss of 1200 mL (IQR: 1000–1550 mL) and a postoperative drainage of 1040 mL (IQR: 723–1293 mL). An extraordinarily high incidence of perioperative hypokalemia was observed, affecting 65.1% of patients (n = 28) intraoperatively and 79.1% (n = 34) postoperatively. All patients successfully underwent surgery with a mean Cobb angle correction rate of 49.0% ± 13.5%. There were no cases of operative mortality, and the overall complication rate was low (2.3%, n = 1). SMA type 2 and type 3 shared similar perioperative parameters.

Conclusions: This study represents the largest case series to date in Asia on the perioperative management of SMA patients undergoing scoliosis surgery. These patients present complex perioperative risks requiring meticulous multidisciplinary care. Advanced airway planning, hemodynamic support, blood management strategies, and proactive correction of electrolyte imbalances may help support safer perioperative care. With appropriate planning, scoliosis surgery can be safely performed in SMA patients, offering structural and functional benefits.

Background: Periprosthetic joint infection (PJI) remains a devastating complication of joint arthroplasty. Although intraoperative frozen section histology (> 5 neutrophils/HPF) is incorporated into the 2018 MSIS diagnostic criteria, its prognostic value for predicting postoperative PJI remains controversial.

Methods: Primary or revision THA/TKA procedures in our hospital between January 1, 2015 and December 31, 2021 with intraoperative frozen section histologic results were eligible for inclusion. Association between intraoperative frozen section histology and postoperative PJI was investigated based on the medical records, and a similar analysis of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) was also performed.

Results: A total of 14,969 knee/hip procedures were identified. After case selection, 797 cases comprising 529 (66.4%) primary and 268 (33.6%) revision were included. According to our data, frozen section positivity showed no PJI association, both in primary (OR, 1.206 [95% CI, 0.133–10.914], P > 0.999) and revision procedures (OR, 1.287 [95% CI, 0.331–5.007], p = 0.717). Conversely, elevated CRP (OR, 15.196 [95% CI, 1.916–120.523], p = 0.001) and ESR (OR, 5.794 [95% CI, 1.4979–22.4129], p = 0.008) predicted PJI exclusively in revisions.

Conclusions: Therefore, isolated positive frozen section results should not be the sole basis for surgical strategy. Elevated CRP/ESR levels during revision surgery warrant heightened vigilance and consideration of extended anti-infective treatment.

Level of Evidence: III.

Objective: Scaphoid nonunion remains a challenging problem due to limited vascularity and carpal malalignment. Although autologous bone grafting remains the standard of care, donor-site morbidity and technical demands can be substantial. NOVOSIS, a composite of recombinant human bone morphogenetic protein-2 (rhBMP-2) and a hydroxyapatite (HA) carrier, has shown osteoinductive and osteoconductive potential in other orthopedic applications, but its clinical efficacy in scaphoid nonunion has not been established.

Methods: Seven consecutive patients with scaphoid waist nonunion underwent fixation using two 2.3-mm headless compression screws and NOVOSIS application between August 2023 and December 2024. All patients were followed for a minimum of 12 months (mean 12.4 months; range 12–14). Clinical outcomes were assessed using visual analogue scale (VAS), range of motion (ROM), and Mayo Wrist Score (MWS). Radiographic parameters included lateral intrascaphoid angle (LISA) and scapholunate angle (SLA). Paired t-tests compared pre- and postoperative values.

Results: All patients achieved radiographic union at final follow-up. VAS scores improved from 4.9 ± 1.2 to 0.4 ± 0.8 (p < 0.001), and MWS from 59.3 ± 7.3 to 94.3 ± 5.4 (p < 0.001). LISA improved from 51.7° ± 13.6° to 31.5° ± 5.1° (p = 0.007), and SLA from 65.7° ± 6.8° to 52.2° ± 8.8° (p = 0.006). No procedure-related complications, such as infection, ectopic bone formation, or donor-site morbidity, were observed.

Conclusion: This preliminary clinical series demonstrated that NOVOSIS provided reliable union, functional recovery, and radiographic correction in scaphoid nonunion without donor-site morbidity. It may serve as a feasible alternative to autologous bone grafting and warrants further validation in larger studies.

Objective: To investigate the incidence and treatment of cerebrospinal fluid leakage due to late presentation of dural tears (LPDT) after lumbar surgery and provide new ideas and treatment options for clinical management. This study addresses a significant knowledge gap in the specific context of delayed CSF leaks, where diagnosis and management remain particularly challenging despite existing literature on CSF leaks in general.

Methods: Patients who underwent posterior lumbar surgery from January 2021 to December 2024 were selected. General patient information, cerebrospinal fluid leakage (CSF) characteristics, follow-up results, and re-examination data were analyzed using chi-squared tests, Fisher's exact tests, t-tests, and ANOVAto identify cases of LPDT, their treatment methods, complications, and clinical outcomes.

Results: A total of 2359 patients who underwent lumbar surgery were included in the study. CSF leakage occurred in 43 patients (1.82%). Dural tears (DT) leading to CSF leakage intraoperatively or within 5 days postoperatively were observed in 36 patients (1.53%), with 23 (0.98%) identified intraoperatively. Seven patients (0.30%) experienced CSF leakage due to LPDT: two of them underwent dural repair surgery 3 weeks and 4 months postoperatively, respectively; five patients received conservative treatment involving wound pressure bandage and bed rest. Clinical outcomes were favorable (good or excellent) in five patients (71.4%) and poor in two patients (28.6%) with LPDT, whereas in contrast, no poor outcomes were observed in non-LPDT patients.

Conclusion: This study found a 0.30% incidence of CSF leakage due to LPDT following lumbar surgery, with these patients demonstrating worse outcomes compared to those with nondelayed CSF leaks. CSF leakage secondary to unrecognized LPDT is an uncommon but clinically significant complication of spine surgery, necessitating heightened awareness and appropriate management.

Objective: Postoperative inflammation and pain remain key barriers to recovery after total knee arthroplasty (TKA). Metformin has anti-inflammatory properties, but its perioperative impact in TKA is unclear. This study evaluated whether regular metformin use reduces postoperative inflammation and pain in T2DM patients undergoing TKA.

Methods: In this single-center retrospective cohort study, patients with Type 2 diabetes mellitus (T2DM) who underwent primary TKA between December 2024 and May 2025 were included. Patients were grouped based on whether they had regularly taken metformin. 1:1 propensity score matching was performed to reduce baseline differences between groups, yielding 60 matched pairs. Inflammatory markers including C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and D-dimer were measured preoperatively and on postoperative days 1 and 3. Pain was assessed using the Visual Analogue Scale (VAS) on postoperative days 1 and 3. Linear mixed-effects models were used to compare outcomes between groups after adjusting for residual confounders.

Results: In the matched cohort, the metformin group showed significantly lower CRP levels on postoperative day 3 (107.04 ± 49.19 vs. 130.91 ± 59.62 mg/L, p = 0.02), lower IL-6 levels on postoperative day 1 (62.22 ± 47.17 vs. 91.07 ± 41.55 pg/mL, p < 0.01), and postoperative day 3 (31.33 ± 20.84 vs. 57.74 ± 59.98 pg/mL, p < 0.01), and lower ESR levels on postoperative day 3 (45.40 ± 17.85 vs. 47.05 ± 20.19 mm/h, p = 0.03) than the non-metformin group. VAS pain scores on postoperative day 3 were also significantly lower in the metformin group (3.03 ± 1.03 vs. 4.15 ± 1.25, p < 0.01). These differences remained significant after adjusting for confounders.

Conclusion: Long-term regular use of metformin is associated with reduced acute inflammation and postoperative pain in T2DM patients undergoing TKA. As a widely used and well-tolerated medication, metformin holds promise as a low-cost, adjunctive therapeutic strategy to enhance early recovery and improve perioperative outcomes in diabetic patients undergoing TKA.

Objective: Given the limitations of current oblique lateral lumbar interbody fusion (OLIF) with internal fixation—such as long operation time, high blood loss, and soft tissue injury—this study evaluates the feasibility, preliminary effectiveness, and biomechanical properties of a modified Anterolateral Transpedicular Transverse Process Screw (ALTTS) technique.

Methods: ALTTS screw placement success rate and key vertebral parameters were evaluated via CT-based simulation in 40 patients (L1–L5). A finite element model of L3-S1 was constructed to compare three OLIF constructs: ALTTS plus bilateral anterolateral screws (ALTTS + BALS), anterior supplemental fixation (ASF), and bilateral pedicle screw fixation (BPSF). Range of motion (ROM), fixation instrument stress, and cage stress were assessed under varying bone quality. Clinically, 12 patients undergoing OLIF with L5 ALTTS and L4 BALS fixation were evaluated using VAS, ODI, and imaging.

Results: Of 200 vertebral bodies, 81 (40.5%) were suitable for ALTTS. The success rate was 0% at L1–L2, 2.5% at L3 (due to vascular constraints), and 97.5% at L5, indicating ALTTS is primarily suitable for the lower lumbar spine, specifically L5. A pedicle width (PW) > 10.21 mm was a key predictor significantly increasing placement success. Biomechanically, under normal bone density, OLIF with ALTTS + BALS demonstrated comparable ROM and stress distribution to BPSF and outperformed ASF. Under osteoporotic conditions, its stability remained superior to ASF but inferior to BPSF. Clinically, the 12 patients showed significant postoperative improvement in VAS and ODI scores, with 3-month CT scans indicating intervertebral fusion, confirming preliminary safety and short-term efficacy.

Conclusions: ALTTS is a lower-lumbar-predominant technique, offering the highest safety and placement success rate at L5, particularly when PW > 10.21 mm. Biomechanically, OLIF with ALTTS + BALS significantly outperforms OLIF with ASF. Preliminary clinical results demonstrate the novel technique is safe, feasible, and effective over a six-month follow-up.

Objectives: Shaft-anchored prostheses have long been the gold standard in shoulder arthroplasty, but there is a growing trend toward bone-preserving, stemless designs. Despite promising short- and midterm results, long-term data remain limited. This study aims to report the long-term outcomes of a stemless anatomic shoulder prosthesis in patients with primary osteoarthritis and seeks to answer the question of whether it is comparable to other prostheses.

Methods: This retrospective single-center study included 27 shoulders in 24 patients (mean age 75 ± 8.3 years), who were operated from 2009 to 2011. Outcomes assessed were Constant-Murley score, range of motion, patient satisfaction, revision rate, and radiological findings. Mean follow-up was 142 ± 12.2 months. Twenty-one shoulders underwent total shoulder arthroplasty; six hemiarthroplasty. For the analysis of continuous variables, the Wilcoxon test was used following normality testing. Dichotomous variables were evaluated using the chi² test, with a significance level set at p < 0.05.

Results: The Constant-Murley score improved significantly from 23.1 ± 9.4 (27.5% age-adjusted) preoperatively to 58.8 ± 18.6 (72.3% age-adjusted) postoperatively (p < 0.001). Range of motion increased in flexion (89.5°–137.2°), abduction (70.9°–117.2°), and external rotation (10°–36.8°), all statistically significant. Overall, 85% of patients were (very) satisfied. Four revisions were performed: two with conversion to alternative treatment, two within the same system due to loosening and infection. Ten- and 12-year survival rates were 89% and 85%, respectively. A 30% risk of loosening was observed (per Molé), though no glenoid loosening occurred; humeral loosening was seen in one case.

Conclusion: The clinical, functional, and radiological outcomes of the investigated stemless shoulder arthroplasty system remain satisfactory even in long-term follow-up. High patient satisfaction was observed. The data, which are unique in terms of the length of follow-up, are comparable to those of other stemless anatomic shoulder arthroplasty designs.

Objective: The reverse Judet approach is a modified technique for scapular fractures, designed to reduce tissue damage and minimize surgical morbidity. However, its comparative efficacy and safety relative to the modified Judet approach have not been well established. Therefore, this study aimed to (1) evaluation of the safety and feasibility of reverse Judet approach for scapular fractures and (2) comparing the advantages and disadvantages of reverse Judet and modified Judet approaches in perioperative indicators and postoperative functional recovery.

Methods: A retrospective analysis was conducted on 40 patients with extra-articular glenoid neck or scapular body fractures admitted between July 2021 and September 2023. The cohort comprised 18 cases in the reverse Judet group and 22 cases in the modified Judet group. Baseline data, surgical parameters (incision length, flap area, operative time, intraoperative blood loss), functional outcomes (DASH score, Constant–Murley score), and complications were recorded.

Results: There were no significant differences in baseline characteristics between the two groups. The reverse Judet group showed significantly better outcomes compared to the modified Judet group in terms of incision length (15.2 ± 1.3 vs. 20.1 ± 1.0 cm, p < 0.001) and flap area (49.5 ± 6.2 cm² vs. 67.4 ± 4.7 cm², p < 0.001). Although not statistically significant, the reverse Judet group tended to have shorter operative times (100.2 ± 20.1 113.4 ± 21.2 min, p = 0.053) and less intraoperative blood loss (136.7 ± 36.0 vs. 155.2 ± 26.9 mL, p = 0.051). Functional assessments showed no significant differences in DASH scores (7.8 ± 2.7 vs. 9.5 ± 4.1, p = 0.156) or Constant–Murley scores (84.3 ± 5.4 vs. 84.1 ± 4.6, p = 0.929) between groups. Neither group experienced nonunion, implant-related complications, or neurovascular injury.

Conclusion: The reverse Judet approach offers benefits such as smaller incisions and less tissue damage while providing adequate exposure for fracture reduction and fixation. Functional recovery is similar to that of the modified Judet approach. Its minimally invasive nature and better esthetic results make it a more comprehensive surgical option for posterior shoulder issues. Although this study did not find an increased risk of flap complications, larger studies are necessary to further improve flap design.

Objectives: Generalized joint hypermobility (GJH) is prototypical clinical feature of hypermobility spectrum disorders, and emerging studies have found a correlation between GJH and structural spinal changes. This study aims to investigate the preoperative radiographic characteristics and clinical outcomes of patients with GJH and adolescent idiopathic scoliosis (AIS).

Methods: Patients with AIS were prospectively recruited between July 2023 and August 2024 and divided into GJH (Beighton score ≥ 6) and non-GJH (Beighton score < 6) groups. The GJH group was matched 1:1 with controls based on age (±1 year), sex, main curve magnitude (±5°), curve type of the Lenke classification, triradiate cartilage status, and Risser stage (±1 grade). Baseline characteristics and surgical data were recorded. Preoperative and immediately postoperative radiographic parameters were measured. The Scoliosis Research Society-22 revised (SRS-22r) questionnaire was collected preoperatively and at least 1 year postoperatively. Univariate analysis and multivariable linear regression analysis were used to identify factors associated with main curve flexibility, TK, and T1 tilt angle.

Results: A total of 136 consecutive patients were included, with 29 patients (21.3%) classified into the GJH group. After mating, the GJH showed greater flexibility of the main curve (60.0% ± 27.7% vs. 45.8% ± 22.1%, p = 0.020) and increased thoracic kyphosis (22.9° ± 11.5° vs. 16.7° ± 11.7°, p = 0.031) compared to the control group. Multivariable linear regression analyses revealed that the GJH was correlated with increased spinal flexibility (β = 14.09, p = 0.015) and larger thoracic kyphosis (β = 6.11, p = 0.043). The GJH group demonstrated a relatively higher risk of surgical complications compared to the non-GJH group (17.2% [5/29] vs. 4.7% [5/107], p = 0.036). However, no significant differences were observed in patient-reported outcome measures (PROMs) between the two groups.

Conclusions: In patients with AIS, GJH is associated with increased spinal flexibility and greater thoracic kyphosis and, importantly, a higher risk of surgical complications.

Objective: Osteonecrosis is a multifactorial pathology of importance in the field of orthopedics and traumatology. The volume of publication and thematic evolution has not been previously analyzed. This study aimed to characterize the scientific production related to osteonecrosis in orthopedics and traumatology, identify the most influential authors, the journals with the highest impact, and the emerging trends in research.

Methods: A bibliometric analysis was performed using the Web of Science Core Collection database. The bibliographic search was performed within the category “Orthopedics,” limiting to original articles up to the year 2024. Reviews and other types of non-original publications were excluded. The analysis was performed with the statistical package Bibliometric (R) and VOSviewer 1.6.17, by manual data cleaning and analysis of co-authorship networks, affiliations and co-occurrence of keywords.

Results: 1620 articles distributed in 78 journals were identified. The year with the highest number of publications was 2024 (131 articles), with an annual growth rate of 29.25%. Michael A. Mont was the most productive author (34 articles) and Stuart Goodman the most cited (23,139 citations). China was the country with the highest number of publications (375), while the United States led in number of citations (9578 total; 26.98 per article). The most productive journals were Journal of Orthopaedic Surgery and Research (414) and International Orthopaedics (365); however, Journal of Arthroplasty (1733) had the highest citation impact. The most frequent keywords were “osteonecrosis,” “core decompression,” and “mesenchymal stem cell.” The most cited article was “Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees” with 451 citations.

Conclusion: Research on osteonecrosis in orthopedics and traumatology has shown sustained growth, with an emerging focus on advanced surgical interventions and regenerative strategies. The United States and China stand out as leaders in volume and impact, respectively. This bibliometric analysis offers key tools to guide future research, strengthen international collaboration, and improve therapeutic strategies in this pathology.

Background: Total en bloc spondylectomy (TES) has emerged as an effective surgical intervention for spinal tumor management. The selection of prosthesis for spinal reconstruction significantly influences patient's postoperative outcomes. This study aims to analyze and compare the biomechanical effects of two types of 3D-printed prostheses and titanium mesh cage (TMC) after TES.

Methods: An intact finite element model (FEM) of L1–L5 segment was developed and validated for simulation. Three L3 TES models were constructed. Model A utilized a 3D-printed prosthesis with an artificial pedicle, model B employed a stand-alone 3D-printed prosthesis, and model C used a TMC. Following parameters were recorded and analyzed to evaluate the biomechanical effects of the three models: (1) the range of motion (ROM), (2) stress of the internal fixation systems, and (3) stress of the L2 inferior endplate and L4 superior endplate.

Results: The ROMs of all three models were significantly restricted in all directions. Compared with TMC, the implantation of 3D printed prosthesis significantly enhanced spinal stability during extension. The ROMs of models A and B were significantly lower than that of model C during extension, decreasing by 15.2% and 36.4%, respectively. The use of 3D-printed prosthesis for anterior column reconstruction could reduce the stress of prosthesis itself and adjacent endplates. Compared with model C, the maximal decrease in the stress of the endplate of models A and B was 41.5% during flexion and 49.1% during right lateral bending, respectively. In all directions, the stress of the prosthesis was largest in model C, followed by model A and smallest in model B, with statistically significant differences observed.

Conclusion: After single-segmental TES, 3D-printed prosthesis with favorable endplate matching could obtain better biomechanical effects, thereby reducing the risk of internal fixation failure and increasing the postoperative spinal stability.

Background: To explore the influence of the new stage and classification system based on the correlation between MRI and pathological features on the collapse, symptoms, and function of femoral head necrosis. Existing radiographic staging systems primarily evaluate structural changes and lesion morphology but provide limited information regarding intraosseous biological activity and pathological heterogeneity. Clinically, patients within the same ARCO stage often demonstrate markedly different symptoms, collapse patterns, and treatment responses, highlighting the need for an MRI-based classification reflecting underlying pathological status.

Methods: This retrospective study included 100 patients (200 hips) who were diagnosed with bilateral ONFH. According to the degree of fibrosis in the necrotic area in a mid-coronal section on hip MRI, the MRI stage of ONFH can be divided into three types. F1, borderline fibrosis (banded low signal); F2, partial fibrosis in the necrotic area (partial low signal); F3, global fibrosis in the necrotic area (global low signal). Based on the level of inflammatory response, the MRI classification of ONFH can be divided into four. E0, pathological stable type (no bone marrow edema and inflammatory); E1, partial edema of the femoral head and neck; E2, global edema of the femoral head and neck; E3, extensive edema of the proximal femur. The radiological evaluations were based on plain X-rays and MRI.

Results: There was a significant difference in the collapse rate between F1 (7.1%), F2 (66.3%), and F3 (92.1%) (p < 0.001). The collapse rate in E0 (11.1%), E1 (66.7%), E2 (85.3%), and E3 (77.8%) was significantly different (p < 0.001). There was also a significant difference in pain level and hip function between MRI stage and classification (p < 0.001). The later the stage, the higher the pain level, and similar results in hip functions. With the aggravation of bone marrow edema, the patient's pain level increases and hip function decreases. ROC analysis demonstrated that MRI stage based on fibrosis showed the highest discriminative ability for femoral head collapse (AUC = 0.819), compared with ARCO stage (AUC = 0.756) and MRI classification based on inflammatory response (AUC = 0.714). However, given the cross-sectional design and the potential for incorporation bias, these findings should be interpreted with caution.

Conclusion: MRI-based assessment of fibrosis extent and inflammatory activity provides additional information on intraosseous pathological status that is not captured by conventional radiographic stage systems and is significantly associated with femoral head collapse, pain, and hip function. This classification may have potential value for disease stratification and clinical assessment. However, its role in guiding treatment decisions and predicting longitudinal outcomes requires further validation in prospective studies.

Objective: The optimal treatment strategy for intra-articular distal radius fractures with loss of reduction in elderly patients remains unclear, particularly in AO/OTA 23-C1 and C2 fracture types. This study aimed to compare the clinical and radiological outcomes of surgical versus conservative treatment in elderly patients who developed secondary displacement after initial reduction.

Methods: In this retrospective multicenter study, 127 patients aged ≥ 65 years with AO/OTA 23-C1/C2 distal radius fractures and secondary displacement during follow-up were analyzed. Patients were managed either with continued conservative treatment (n = 78) or delayed surgical intervention (n = 49). Radiological parameters (volar tilt, radial inclination, ulnar variance, and articular step-off) and functional outcomes were evaluated at 3 and 12 months using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and the Patient-Rated Wrist Evaluation (PRWE). Grip strength was assessed bilaterally at the 12-month follow-up. Independent predictors of conversion to surgical treatment were identified using multivariate logistic regression analysis.

Results: At the 3-month follow-up, the surgical group demonstrated significantly better radiological alignment and lower QuickDASH and PRWE scores compared with the conservative group (p < 0.01). Grip strength on the injured side was similar between groups; however, relative strength loss compared with the uninjured side was significantly lower in the surgical group (p = 0.001). At 12 months, no significant differences were observed between groups in either radiological or functional outcomes. Implant-related irritation was more frequent in the surgical group (p = 0.01), whereas malunion occurred more commonly in the conservative group (p = 0.047). Independent predictors of surgical intervention included AO/OTA 23-C2 fracture type (OR: 2.677; p = 0.023) and progressive deterioration in alignment during follow-up (OR: 15.1; p = 0.001).

Conclusion: Surgical treatment provided superior short-term radiological and functional outcomes in elderly patients with distal radius fractures complicated by loss of reduction; however, long-term outcomes were comparable between treatment strategies. Treatment decisions should be individualized, taking into account fracture pattern, alignment stability during follow-up, and patient-specific factors.

Objective: Accurate and efficient patient registration remains a critical challenge in robot-assisted spine surgery, where current methods often rely on invasive bone-mounted frames or intraoperative imaging that increases radiation exposure and procedural complexity.

Method: This article presents a novel non-invasive and contactless spine registration system that integrates a skin-affixed, radiopaque floating-point mask with a robot-mounted monocular camera. The system was evaluated in phantom experiments to quantify registration accuracy and pedicle-screw-axis targeting performance. The system autonomously establishes the pose of the pedicle-screw axis relative to the mask (patient) and surgical robot coordinate systems. A monocular camera mounted on the robot captures live images of the mask in the operating theater, enabling real-time visual recognition and tracking of the mask's elements. Advanced segmentation and pose estimation algorithms compute the spatial relationship between the vertebrae and the mask, accounting for accurate angular displacement between preoperative imaging and intraoperative patient posturing (CT-to-OT shift).

Results: Experimental validation on anatomically curved spine phantoms demonstrates millimeter accuracy in pedicle-screw path localization. The system facilitates accounting for changes in patient configuration from CT scan posture to OT surgical posture to provide an objective and accurate reference for image-guided pedicle screw placement. It eliminates intraoperative imaging while relying on preoperative CT and the registration was completed in under 4 min per vertebra.

Conclusion: The proposed system facilitates accounting for changes in patient configuration from CT scanner posture to OT surgical posture to provide an objective and accurate reference for image-guided screw placement, achieving registration within 4 min per vertebra. The invention facilitates frame-free patient registration both in manual and robotic spine surgery. The work lays the foundation for clinical translation through future cadaveric and pilot studies. All results reported in this study are limited to controlled laboratory and phantom conditions. Clinical performance and intraoperative feasibility remain to be established in future patient studies.

Background: Knee osteoarthritis (OA), a leading cause of disability, disproportionately affects women and the elderly, contributing significantly to health burdens. This study aims to analyze the temporal trend and future projection of knee OA burden in China, using data from the Global Burden of Disease (GBD) 2021.

Methods: The research employed age-period-cohort (APC) and autoregressive integrated moving average (ARIMA) models to examine the effects of age, period, and cohort on the incidence and disability-adjusted life years (DALYs) of knee OA from 1990 to 2021, with projections for the next 15 years.

Results: Findings show a substantial increase in knee OA incidence and DALYs over the past three decades, particularly among women, with a notable age-dependent rise. The ARIMA model predicts a gradual decline in knee OA incidence and DALYs after 2021, potentially due to healthcare reforms and preventive strategies.

Conclusion: The study underscores the growing healthcare burden of knee OA in China and highlights the need for effective prevention, early diagnosis, and improved healthcare infrastructure to manage this increasing public health issue.

Objective: Spondylolysis is a common cause of low back pain, especially in the young athletic population. It involves a defect, either unilateral or bilateral, of the pars interarticularis. Numerous techniques have been developed for the surgical treatment of spondylolysis, each with its own strengths and weaknesses. This article aims to describe a modified minimally invasive technique using cortical bone trajectory screws with a U-rod to stabilize the lumbar spondylolysis.

Methods: Adult patients who presented between July 2020 and August 2024 with low back pain due to spondylolysis were included in this study. Imaging studies of the lumbar spine were performed to confirm the spondylolysis. All patients were confirmed to be treated conservatively for at least 12 months prior to surgical intervention. A 2.5 cm midline incision was made at the level of the spondylolysis. Under fluoroscopic guidance, two screws were inserted into the level of the spondylolysis in the cortical bone trajectory, and the screws were connected with a U-shaped bent rod.

Results: Four adult patients (one male, three females) were included. The mean age was 38.5 ± 16.1 years. Average intraoperative blood loss was 6 ± 3 mL. Mean postoperative hospital stay was 3 ± 0.5 days. Both postoperative visual analog scale (VAS) and Oswestry disability index (ODI) scores showed significant improvement. Lumbar spine CT scans performed 1-year post-operation confirmed fusion of the pars defect in seven of the eight defects.

Conclusion: We described a modified minimally invasive technique for the treatment of spondylolysis. This approach offers the advantage of being minimally invasive, leading to less blood loss, short hospital stays, and fast recovery. It also requires less technical expertise than traditional pars screw placement and utilizes readily available instrumentations. Patients reported improved pain scores, and imaging confirmed successful fusion of the pars defect.

Objective: With the progress of spinal tuberculosis treatment theory and surgical tools, how to further improve the surgical efficacy, reduce surgical trauma, and increase safety in multi-segmental spinal tuberculosis is still controversial. Through the improvement of traditional posterior surgery, we explored the posterior Detour method to preserve bilateral lamina in the treatment of multi-segment thoracolumbar tuberculosis and followed up on its clinical efficacy and imaging results to observe its clinical value and further evaluate its effectiveness and safety.

Methods: Between January 2022 and December 2024, 32 patients suffering from multi-segment thoracolumbar tuberculosis underwent the combined anterior and posterior approach, or the “detour” method, and were divided into the Anterior–Posterior group (AP, 15 patients) and the Detour group (17 patients). Demographic characteristics, surgical details, and radiological outcomes were collected for analysis.

Results: Thirty-two patients were included in the study, including 15 patients treated with the AP technique and 17 patients treated with the Detour method. Significant differences were found in surgery time, total postoperative drainage volume, and time to first out-of-bed activity. The two groups were similar in sex, BMI, smoking and drinking history, corrected Cobb angle, VAS, CRP, and ODI.

Conclusions: Compared with combined anterior and posterior procedures, the “Detour method” enables a 180° decompression of the spinal cord and 270° reconstruction scope within a smaller incision, providing a safe and effective method for the treatment of multi-segmental spinal tuberculosis.

Objective: Kümmell disease is a prevalent spinal condition characterized by vertebral fractures and subsequent spinal nerve injury, significantly impacting patients' quality of life and imposing a considerable economic burden on society. Current treatment modalities, including percutaneous vertebroplasty (PVP) and kyphoplasty (PKP), often fail to alleviate symptoms or restore vertebral height in advanced stages of the disease, highlighting the urgent need for improved surgical interventions. This study aims to evaluate the surgical outcomes of short-segment fixation combined with leverage reduction technique in patients with Kümmell disease accompanied by kyphosis deformity.

Methods: A retrospective analysis was conducted on 22 patients who were treated with short-segment fixation and leverage reduction technique between 2020 and 2023. Clinical evaluation, including operation time, blood loss volume, and postoperative complications, were collected. The visual analog scale (VAS) score for pain and Frankel classification were used to evaluate the patients' functional outcome. The radiographic analysis included local kyphotic angle (LKA), regional kyphotic angle (RKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and sagittal compression (SC). The student t-test and the χ²-test (or the Fisher exact test) were used to compare the outcome measures between the preoperative group and postoperative group.

Results: The results demonstrate that the surgical technique led to limited intro-operative blood loss (average 85.7 ± 29.4 mL) and short surgery duration (average 100.1 ± 36.3 min), and significantly improved pain status postoperatively (p < 0.05). Average vertebral height restoration reached 83% ± 14% of predicted normal height, with mean kyphotic angle correction of 19.32° ± 6.27°. Notably, the proportion of patients classified as Frankel grade D and E improved significantly at the last follow-up (p < 0.05), indicating favorable neurological recovery. Although there was an instance of cement leakage, no severe complications such as internal fixation failure or neurological damage occurred.

Conclusions: The results suggest that short-segment fixation combined with leverage reduction technique is a promising surgical strategy for patients with Kümmell disease and kyphosis deformity, effectively alleviating pain, restoring vertebral height, and promoting neurological recovery.

Background: Revision total knee arthroplasty (rTKA) poses substantial technical challenges. Although robotic assistance has demonstrated efficacy in primary TKA, its application in partial revision procedures remains poorly understood. This study presents a case of robotic-assisted partial rTKA—specifically, isolated tibial component revision using the retained femoral component as a registration reference—and provides a comprehensive review of the current literature.

Case Presentation: A 66-year-old male presented with progressive knee pain 8 years after left TKA. Imaging revealed a well-fixed femoral component but isolated aseptic loosening with posterior tilting of the tibial component. Given the stability of the femoral component, a robotic-assisted partial revision targeting only the tibial component was performed. The robotic system was registered intraoperatively using the well-fixed retained femoral component as the primary reference, enabling accurate spatial orientation despite the altered tibial anatomy. A critical prerequisite for this procedure was implant compatibility between the retained Triathlon femoral component and the planned Triathlon TS revision system. After removal of the loose tibial tray and debridement, robotic-arm guidance was used for precise tibial osteotomy with a 10 mm augment. Postoperative imaging confirmed optimal component positioning. The patient achieved 0°–130° range of motion within 2 weeks, with favorable short-term clinical and radiological outcomes at 1 year follow-up.

Conclusion: This case demonstrates the technical feasibility of robotic-assisted partial TKA revision, with favorable short-term clinical and radiological outcomes at 1 year follow-up. The technique enabled precise osteotomy, balanced gap restoration, and preservation of the well-fixed femoral component. While these preliminary results are encouraging, larger studies with longer follow-up are needed to establish comparative effectiveness and generalizability.