Distal radius fractures of OTA/AO types 23B and 23C have a high incidence, and inadequate treatment can lead to complications such as traumatic arthritis, joint pain, and limited wrist function. This study aimed to utilize three-dimensional computed tomography (3D-CT) reconstruction technology and fracture line mapping frequency charts to intuitively and clearly describe the morphological characteristics of distal radius fractures (OTA/AO types 23B and 23C), thereby deepening the understanding of such fractures and providing reference information for this clinical condition. Patients with OTA/AO types 23B and 23C distal radial fractures who met the inclusion criteria at our hospital were retrospectively analyzed. A three-dimensional model of the fracture was established using CT scans. The articular surface fracture model and the articular depression area were superimposed on the standard model, and the fracture line map, frequency map, and articular depression map were generated. This study included 212 patients, comprising 67 males and 145 females. There were 104 left-hand fractures and 108 right-hand fractures. The mean age of the enrolled patients was 59.71 ± 13.21 years, ranging from 18 to 88. In terms of injury mechanisms, 172 (81.13 %) resulted from falls, 17 (8.02 %) from falls from height, 12 (5.66 %) from accidents, and 11 (5.19 %) from other factors. The main fracture lines and areas of high fracture frequency were located in the lunate fossa, scaphoid fossa, and its dorsal region. In the fracture frequency map, the high-frequency fracture area exhibited a clear "+" shape pattern, particularly in the dorsal and central regions of the scaphoid fossa, where the fracture involvement frequencies reached 76 % and 67 %, respectively. Conversely, the four corners of the nine segments of the articular surface of the distal radius were less frequently involved, with frequencies in the radial volar and ulnar volar regions at 18 % and 26 %, respectively. Compared to the palmar side, the dorsal side showed more depressions. The depressed area was the most frequently involved part, notably located in the center and dorsal area of the lunate fossa and scaphoid fossa. The intra-articular fracture line map, frequency map, and articular depression map of the distal radius were created to reveal the morphological distribution characteristics of fracture lines of types 23B and 23C in the OA classification, allowing for the intuitive identification of prone fracture sites, which may aid clinical diagnosis and surgical guidance.
International collaboration has increased across scientific fields, yet its role within orthopaedic surgery remains poorly defined. Although global orthopaedic research output has expanded, the extent of international authorship within leading journals and its relationship to academic influence are not well understood. This study examined long-term publication patterns to compare international and single-country authorship and to determine whether collaborative research is associated with greater citation impact. This bibliometric study analyzed 91,799 original research articles published from 1990 to 2019 in fifteen major orthopaedic journals. Articles were classified as single-country publications or international collaborations based on the institutional affiliations of contributing authors. Citation counts and citations per publication per year were calculated. Multivariable linear regression was used to evaluate the association between international collaboration and citation impact while adjusting for established citation-related factors. Propensity score matching using a three-to-one nearest-neighbor approach was performed to reduce confounding. Of 91,799 articles, single-country publications accounted for 87.7 percent overall but decreased over time, while international collaborations increased from 5.9 percent in the 1990s to 15.8 percent in the 2010s. Collaborative publications received more total citations and more citations per publication per year than single-country publications. Collaborative studies also had more authors, keywords, and references, and were more likely to report funding and open access. Regression and matched analyses identified international collaboration as an independent predictor of higher citation impact. The United States produced the largest number of publications and demonstrated higher citation rates when collaborating internationally. International collaboration in orthopaedic research has increased substantially and is associated with greater academic influence compared with research conducted within a single country. These findings highlight the value of global engagement in producing high-impact orthopaedic scholarship.
Arthroscopic techniques for the knee joint continue to evolve, driven by the global shift toward "save the meniscus" and refinement of anterior cruciate ligament reconstruction technique. The purpose of this study was to evaluate nationwide trends in meniscal surgery and anterior cruciate ligament reconstruction in Japan using three years of data from the Japan Sports Orthopaedic Association registry. This registry-based study analyzed arthroscopic knee procedures performed by Japan Sports Orthopaedic Association member surgeons between April 2021 and March 2024. Extracted data included isolated medial and lateral meniscus procedures, repair techniques, primary and revision anterior cruciate ligament reconstructions, graft selection, and concomitant meniscal treatments. There were 51,074, 52,681, and 54,841 arthroscopic knee surgeries in 2021, 2022, and 2023, respectively. Medial meniscal repair increased annually (37.6%-41.9%), and lateral meniscal repair exceeded resection across all years. Arthroscopic meniscus resection decreased both in medial and lateral meniscus resections over time. The all-inside with anchor device technique was common in medial (43.2%-49.9%) and lateral (37.3%-48.9%) meniscus repairs. The inside-out, outside-in, intra-articular all-inside, and pull-out techniques were also frequently performed. Primary anterior cruciate ligament reconstructions increased from 12,114 to 13,500 cases, with hamstring autografts predominant (>80%), but decreased slightly over time. Quadriceps tendon autografts increased from 1.5% to 3.8%. The number of revision anterior cruciate ligament reconstruction cases was 1,072, 1,669, and 1,084, respectively. Bone-patellar tendon-bone autografts were the most commonly (∼60%) used for revision anterior cruciate ligament reconstructions. Hamstring autografts decreased from 33.6% to 28.4%, with quadriceps tendon graft use increasing from 8.3% to 11.6%. This study provides the first nationwide analysis of arthroscopic knee surgery focusing on meniscus and anterior cruciate ligament procedures in Japan, demonstrating increasing adoption of meniscal repair and changing graft selection patterns in anterior cruciate ligament reconstruction.
Most physicians and trainees who provide initial treatment for orthopedic trauma in emergency rooms (ER) are not specialists in orthopedics. While validated clinical decision rules have been established for injuries of the lower extremities, head, and spine, the diagnostic evaluation of upper extremity trauma remains less standardized, and detailed analyses of misdiagnosis in upper limb fractures are limited. The purpose of this study was to examine the validity of the initial diagnosis of upper limb fractures in our ER and investigate the factors in misdiagnosis. This retrospective study included patients who presented to our emergency department with upper extremity trauma and underwent plain radiography for suspected fractures over a one-year period. Board-certified orthopedic surgeons and a radiologist retrospectively evaluated these cases. We examined the locations and characteristics of fractures misdiagnosed in the ER and analyzed patient-related and clinical factors associated with misdiagnosis. We also investigated the clinical outcomes of the misdiagnosed cases. 1481 injuries in 1469 patients were evaluated in this study. The ER physicians initially diagnosed 436 injuries as fractures, whereas 485 injuries were ultimately confirmed as fractures. Seventy-one injuries (4.8%) in 66 patients were determined to be misdiagnosed: There were 60 missed and 11 overcall cases. There were significant differences in the misdiagnosis rate depending on the fracture site (p < 0.01), and the rate for carpal and scapula fractures was high. There was a tendency for the senior resident to have more misdiagnosis than other physicians (p = 0.06). The time from radiography to leaving the hospital was significantly shorter in the misdiagnosed cases than in the cases correctly diagnosed (p = 0.01). In ER practice, there were many misdiagnoses in scapular and carpal bones. To prevent misdiagnosis, it is suggested that double-checking with other physicians is an important process in ER. In addition, it is necessary to establish a follow-up system because half of the misdiagnosed cases could not be contacted after the ER visit.
In pectoralis minor muscle (PMiM) transfer, the PMiM tendon is typically harvested with a bone chip using a chisel from the medial surface of the coracoid process, as it is primarily composed of muscle tissue. However, variations in the insertion patterns and attachment sites of the PMiM tendon on the coracoid process have been reported, which may affect surgical techniques. This study aimed to investigate the anatomical variations in the attachment site of the PMiM tendon to the coracoid process using cadaveric shoulders. The attachment site of the PMiM tendon to the coracoid process was examined in 22 cadaver shoulders. The coracoid length and width were also measured as indicators of body size. In 11 of the 22 shoulders, the PMiM tendon was attached to the medial surface of the coracoid process. In the remaining 11 shoulders, the tendon was attached to either the superior or medial-to-superior surface, with the tendon extending toward the glenohumeral joint. The mean coracoid length and width were 42.1 ± 4.2 mm and 17.1 ± 2.1 mm, respectively, and both measurements were significantly greater in shoulders with medial surface attachments (P < 0.05). The PMiM tendon was attached to the medial surface of the coracoid process in 50 % of the examined shoulders. Shoulders with medial surface attachments exhibited significantly greater coracoid lengths compared with those with superior or medial-to-superior attachments. These anatomical insights may assist in reducing the risk of damaging the muscle-bone junction during PMiM tendon harvesting for surgical transfer.
In Japan, secondary screening for developmental hip dysplasia has expanded. However, the capacity of screening programs has outpaced the availability of ultrasonography and the number of clinicians who perform and interpret examinations outside tertiary centers. Plain radiography is widely accessible; however, interpreting images in infants can be challenging. This study developed and validated a deep learning-based system to support radiographic diagnosis and test a prespecified two-step triage strategy for clinical use. Overall, 1188 anteroposterior pelvic radiographs of infants aged 2-12 months were retrospectively analyzed. Three non-overlapping test subsets (50 images each) represented routine screening, images without a visible femoral-head ossification center, and images from external hospitals; the remainder were used for training and internal validation. The system generates measurements and the International Hip Dysplasia Institute grades for each radiograph. All test images were independently graded by two pediatric orthopedic surgeons, and the consensus served as a categorical reference. The agreement was summarized using the intraclass correlation coefficient for measurements and quadratic-weighted kappa for grades. The triage strategy was as follows: (1) no further imaging or referral when both hips were grade 1, and (2) high-priority alert when either hip was grade ≥2 and/or the acetabular angle was at least 25°. Agreement for the principal measurement between the system and each reader was 0.83-0.84 by intraclass correlation, comparable to inter-reader agreement (0.81), with small biases and acceptable limits of agreement. For grades, quadratic-weighted kappa was 0.63-0.75 across subsets, with disagreements mainly between adjacent categories. With a 25-degree cutoff, the triage strategy achieved sensitivities of 0.75-0.93 and specificities of 0.62-0.95 across subsets. The system supported radiographic screening decisions across diverse images typical of this age range, achieving comparable agreement with clinicians. Therefore, a prospective multicenter evaluation with thresholds adjusted for age and location is required.
This study aimed to evaluate the short-to mid-term outcomes of the Global Modular Replacement System (GMRS) rotating-hinge knee prosthesis (Stryker) used in joint function reconstruction for bone and soft-tissue tumors and metastatic bone tumors. This study included patients who underwent lower limb joint function reconstruction using cemented GMRS rotating-hinge knee prosthesis at our hospital and were followed up for >2 years between July 2012 and December 2024. The implant and revision-free survival rates were evaluated, and complications requiring additional surgery were recorded. A total of 72 patients (31 males and 41 females) with an average age of 47 years (range, 13-84 years) were included in this study. The average follow-up period was 72.2 months (range, 26-148 months). The replacement sites were the distal femur in 50 cases, the proximal tibia in 21 cases, the total femur in 1 case. Of the 72 patients, 55 underwent initial surgery, and 17 underwent revision surgery. The 5-year implant survival rate was 86.7% (64/72), and the 5-year revision-free survival rate was 77.5% (58/72). The estimated 10-year implant survival rate remained 86.7%, indicating no additional implant failures after 5 years. Of the 72 patients, 14 (19%) underwent additional surgery due to infection (n = 7: 3 distal femoral replacement and 4 proximal tibial replacement), aseptic loosening (n = 4: 3 distal femoral replacement and 1 proximal tibial replacement), implant incompatibility (n = 1), and tumor recurrence/metastasis (n = 2). Cemented GMRS rotating-hinge knee prostheses demonstrated favorable short-to mid-term outcomes with stable implant survival beyond 5 years in this Japanese cohort. These findings supportthe mechanical durability of cemented GMRS reconstruction for limb salvage surgery around the knee.
Postoperative hyperglycemia secondary to surgical stress predisposes patients to infection regardless of diabetes status, including after total knee arthroplasty (TKA). However, glycemic changes following TKA in patients without diabetes mellitus (DM) remain incompletely understood, as do the risk factors for postoperative hyperglycemia. We investigated detailed blood glucose level (BGL) changes, including those before each meal, and examined risk factors for postoperative hyperglycemia in non-diabetic TKA patients. In this prospective study, 147 knees of 129 patients without DM who underwent TKA between July 2021 and November 2025 were included. Their BGL were measured preoperatively, at 9 PM on the day of surgery, and before every meal until the morning of postoperative day (POD) 3. The BGLs at each measurement time point were compared using one-way analysis of variance. Risk factors for hyperglycemia at the time of the highest postoperative BGL were assessed using multivariate regression analysis. And the cut-off values of risk factors obtained through the multiple regression analysis for predicting hyperglycemia above 140 mg/dl were evaluated using the receiver operating characteristics curve. Compared to preoperative levels, mean BGL was significantly higher from the day of surgery to the evening of POD 2, peaking at mid-day on POD 1. Multiple regression analysis revealed that an increased BGL at the mid-day on POD 1 was significantly associated with advanced age, with a cut-off value of 76 years for predicting hyperglycemia, area under the curve of 0.601 (P = 0.035), and sensitivity and specificity of 58.0% and 61.5%, respectively. BGL after TKA in non-diabetic patients remain significantly higher than preoperatively until the evening of POD 2, with the highest mean BGL at mid-day on POD 1. Hence, careful monitoring of BGLs is necessary until the evening of POD 2, particularly in patients aged 76 years or older.
Spontaneous posterior interosseous nerve (PIN) palsy is a rare condition with controversial clinical features. Although this palsy is conventionally treated conservatively, interfascicular neurolysis to release hourglass-like fascicular constrictions has also been recommended. This study aimed to clarify the clinical characteristics and treatment guidelines for this palsy. Fifty-eight limbs with spontaneous PIN palsy receiving conservative treatment or interfascicular neurolysis. The presence of pain as a premonitory symptom and the degree of muscle weakness were investigated. Patients were followed periodically from 3 months after palsy onset to either recovery or ≥36 months afterwards. Limbs recovering to manual muscle testing (MMT) grade 4 or better for both the extensor pollicis longus and extensor digitorum were rated as Good recovery, with all others judged as Poor. Good recovery was achieved in 31 of 34 limbs treated conservatively and 19 of 24 of limbs by interfascicular neurolysis. Younger age at onset was the factor significantly associated with achieving Good recovery in 58 limbs treated by conservatively or interfascicular neurolysis. In the 24 limbs treated by interfascicular neurolysis, early timing of surgery was the factor significantly associated with attaining Good recovery. All 27 limbs with conservative treatment displaying ≥1 grade of MMT improvement within 6 months after onset achieved Good recovery. In the 23 limbs with Poor recovery at 6 months by conservative treatment, Good recovery was attained in 4 of 7 limbs by continuing conservative treatment and in 12 of 16 limbs by subsequent interfascicular neurolysis. Although the latter treatment tended to produce better results, no significant difference was detected. Diverse clinical characteristics of spontaneous PIN palsy are useful for diagnosis. Conservative treatment is advisable within 6 months after onset of palsy. If no improvement is observed, interfascicular neurolysis without delay is a reasonable option.
Periprosthetic femoral fracture is a serious complication following total hip arthroplasty. Compared with composite-beam stems, polished taper-slip stems have been reported to carry a higher risk of periprosthetic femoral fractures. However, long-term multicenter data on the incidence of periprosthetic femoral fractures following cemented and hybrid total hip arthroplasty using the Exeter polished taper-slip stem, particularly in Japan, remain limited. A retrospective multicenter cohort study using registry data from seven Exeter teaching hospitals in Japan was conducted. A total of 8499 primary cemented and hybrid total hip arthroplasties performed between 1999 and 2021 were analyzed. Postoperative periprosthetic femoral fractures were identified and classified according to the Vancouver classification. Treatment modalities-including conservative management, open reduction and internal fixation, and revision arthroplasty-were evaluated. Patient- and implant-related factors were compared between patients with and without periprosthetic femoral fractures, and multivariable logistic regression analysis was performed. A total of 22 postoperative periprosthetic femoral fractures were identified, yielding an incidence of 0.26% (95% confidence interval, 0.16-0.39%). The median time to fracture was 8.1 years (interquartile range, 2.7-12.0). Most fractures were classified as Vancouver types B1, B2, and C. Atypical fracture morphologies associated with polished taper-slip stems, such as sickle-type or axe-splitter patterns, were rarely observed. Half of the fractures were treated with open reduction and internal fixation, and one-third required revision arthroplasty. Cement-in-cement revision was feasible in most revision cases. This multicenter study demonstrated a very low incidence of long-term periprosthetic femoral fractures following cemented and hybrid total hip arthroplasty using the Exeter stem. These findings underscore the reliability of polished taper-slip designs; however, further validation in larger, and more diverse populations is warranted.
Brachial plexus injury (BPI) is the most devastating peripheral nerve injury that occurs following high-energy trauma. Rarely, patients with functional neurological disorders (FND) are referred to orthopaedic surgeons with symptoms mimicking brachial plexus injury. This study investigated the clinical features and prognosis of patients with psychogenic upper limb paralysis who were referred to our department because of suspected brachial plexus injury. The study included 13 patients who were referred to a university hospital between 2013 and 2023 with suspected BPI from the referring hospital but were diagnosed with FND based on physical, imaging, and neurophysiological examinations. There were eight men and five women, mean age was 31.5 years (range, 13-54 years). The referral hospital, mechanism of injury, timing of symptom onset (paralysis development), initial physical examination findings, and prognosis (course of recovery) were retrospectively reviewed. None of the patients exhibited muscle atrophy, all had normal upper limb tendon reflexes, and a discrepancy was noted between the levels of motor weakness and sensory impairment. All patients were referred by orthopaedic surgeons with a presumed diagnosis of brachial plexus injury. The primary treatment involved helping patients realize they could move their limb through direct electrical stimulation to the brachial plexus, without explicitly stating that the paralysis was psychogenic. More than half of the patients showed improvement during follow-up. A meticulous physical examination is crucial for distinguishing FND from BPI. All patients were referred by orthopaedic surgeons, highlighting that BPI is a difficult diagnosis, even among specialists.
The prevalence of central neuropathic pain (cNeuP) is increasing, particularly in older patients with spinal cord injury (SCI) without radiographic abnormalities resulting from minor external forces. Preclinical research has shown the effectiveness of gabapentinoid treatment for cNeuP after SCI in the spinal cord without stenosis. However, no studies have reported the efficacy of this treatment in models of spinal cord compressive lesions. To determine the effects of mirogabalin for cNeuP after SCI in a rat model of chronic spinal cord compressive lesions. A model of chronic spinal compressive lesion was created in rats by inserting an expandable water-absorbing polyurethane sheet under the sublaminar space. After 8 weeks, SCI without radiographic abnormalities causing hypersensitivity was induced using an Infinite Horizon Impactor device. The rats with cNeuP were divided into 3 groups: a saline group, a high-dose mirogabalin besylate (MGB) group, and an MGB low-dose group. Pain-related behavior and histology were evaluated for up to post operative 28 days. Compared with rats in the saline-treated group, those in the MGB-treated groups presented an increased pain threshold. Significant improvement was observed in MGB-treated rats for up to 21 days. Histology and mRNA expression revealed reduced expression of Iba-1 and α2δ-1 in MGB-treated rats. Administration of MGB decreased Iba-1 and α2δ-1 immunoreactivity in the dorsal horns of a rat model of cervical SCI at 4 weeks after injury. The inhibitory effect of MGB on the α2δ-1 subunit after SCI may contribute to the analgesic effect on cNeuP.
Posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL) is commonly performed using laminoplasty (LAMP) or posterior decompression with fusion (PDF). However, the relative benefits and risks of these procedures remain uncertain. This study aimed to compare clinical and radiographic outcomes between LAMP and PDF using a systematic review and meta-analysis. A systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies comparing LAMP and PDF for cervical OPLL. Extracted data included neurological function, Neck Disability Index (NDI), neck pain, postoperative complications, and sagittal alignment. Neurological improvement was assessed using the Japanese Orthopaedic Association (JOA) score and recovery rate, with subgroup analyses performed according to K-line status. Meta-analyses were conducted to compare outcomes between procedures. The certainty of evidence was evaluated using the GRADE approach. Seventeen studies were included. Overall neurological recovery was similar between LAMP and PDF. In subgroup analysis, PDF demonstrated significantly greater improvement in patients with K-line (-) OPLL. Neck Disability Index scores did not differ between procedures. Postoperative neck pain was more frequent after PDF, and complication rates were consistently higher with PDF. Sagittal alignment parameters, including C2-7 sagittal vertical axis and C2-7 cervical lordosis angle, were similar between the two procedures. Neurological improvement following posterior decompression for cervical OPLL was similar between LAMP and PDF overall. While PDF showed significantly greater improvement in patients with K-line (-) OPLL, it was associated with higher rates of postoperative neck pain and complications. These findings indicate that PDF was associated with greater neurological improvement in patients with K-line (-) OPLL; however, this finding should be interpreted with caution given the observational nature of the included studies and the very low certainty of evidence, and should be considered hypothesis-generating.
Instrumented arthrometers are widely used to quantify anterior knee laxity in the diagnosis and follow-up of anterior cruciate ligament (ACL) injuries. The KNEELAX3 enables computerized measurement of anterior tibial translation (ATT); however, device-specific normative data and reproducibility in healthy women have not been fully established. This study aimed to determine reference ATT values in healthy Japanese women and to evaluate the reliability of KNEELAX3 measurements. Sixty healthy Japanese women (mean age 27.1 ± 3.6 years) with no history of knee pathology were included. The ATT was measured at 132 N with the knee in 20° of flexion. Three experienced examiners performed the measurements. Examiner A conducted repeated measurements on separate days to assess intra-rater reliability, and all three examiners measured on the same day to assess inter-rater reliability. Reliability was evaluated using intraclass correlation coefficients (ICC). Bland-Altman analysis was performed to assess systematic error and calculate the minimal detectable change at the 95% confidence level (MDC95). Mean ATT was 5.5 ± 1.8 mm on the right and 6.4 ± 1.8 mm on the left, indicating a small side-to-side difference in these healthy individuals. Intra-rater reliability was moderate to good (ICC 0.75-0.88), and inter-rater reliability was moderate to good (ICC 0.76-0.87). The ICC for side-to-side differences was lower (0.44-0.56), indicating limited reliability compared with absolute ATT measurements. No proportional bias was detected in any analysis. However, fixed bias was observed between one examiner and the others in the right knee. The MDC95 for absolute ATT ranged from 1.84 to 2.58 mm, and 2 mm for side-to-side differences, suggesting that smaller differences may fall within measurement variability. KNEELAX3 demonstrated clinically moderate to good reliability for measuring ATT in healthy women. Side-to-side differences showed limited reliability and should be interpreted with caution, particularly when small. Differences approaching 2-3 mm may exceed measurement variability; however, interpretation should be device-specific and integrated with clinical findings. Standardized measurement techniques are important to minimize examiner-dependent variability.
This study examined the effect of improvements in cervical extension function on quality of life (QOL) in patients with dropped head syndrome (DHS) using patient-reported quality of life (PRQOL). A total of 116 DHS patients were divided into three groups according to cervical extension function at the end of outpatient physical therapy: Non-improvement group (unable to sphinx prone position), Improvement group (able to sphinx prone position), and Marked-improvement group (able to sphinx prone position and all-fours position). Disease-specific QOL (DHS-QOL scale) and health-related QOL (EQ-5D-3L) were assessed both before and after physical therapy, and the PRQOL results were compared among groups. The Non-improvement group showed no significant changes in either scale. In contrast, the Improvement group demonstrated moderate gains in both DHS-QOL and EQ-5D-3L, while the Marked-improvement group showed the greatest improvements, with large effect sizes across both measures. These findings indicate that enhancement of cervical extension function was strongly associated with PRQOL improvement. Cervical extensor improvement in DHS patients contributes not only to physical function but also to patient-perceived QOL. Acquisition of cervical extension in the all-fours position may serve as a clinically meaningful goal for improving QOL in DHS patients.
Mild cervical ossification of the posterior longitudinal ligament (OPLL) is often asymptomatic or minimally symptomatic; however, its impact on physical function remains unclear. Locomotive syndrome (LS), a condition involving a decline in mobility due to musculoskeletal disorders, may help predict early functional impairments beyond neurological deficits. This study aimed to assess the severity of LS in patients with mild OPLL using the locomotive syndrome risk test battery. This cross-sectional study included 37 patients with mild OPLL (Japanese Orthopaedic Association score ≧16 points) and 73 propensity score-matched controls with no major comorbidities. All participants underwent three LS assessments: the stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25). LS stages were defined according to the Japanese Orthopaedic Association criteria. Group comparisons were performed using Student's t-test and the Chi-Square test. The OPLL group demonstrated significantly lower two-step and stand-up test scores (P < 0.05) and higher GLFS-25 scores (P = 0.0102) than controls. A significantly higher proportion of the OPLL group was classified as having LS stage 2 (32.4 % vs. 15.1 %, P = 0.0017), indicating more advanced locomotor dysfunction. Patients with mild cervical OPLL and preserved neurological function exhibited greater LS severity and subjective disabilities. The GLFS-25 effectively captured functional and psychosocial burden not reflected in traditional neurological scores, suggesting the need for early screening and mindful diagnostic communication.
Subtrochanteric femoral fractures are challenging injuries that are often associated with complications such as malrotation. Although imaging indicators such as the lesser trochanter sign are commonly used to achieve proper rotational alignment during surgery, their reliability diminishes in the presence of lesser trochanter fragments. This study investigated the relationship between lesser trochanter fragments and rotational deformities in patients treated with antegrade intramedullary nailing for subtrochanteric fractures. This multicenter retrospective analysis included 40 patients who underwent surgery for subtrochanteric fractures. Femoral anteversion was measured using preoperative and postoperative computed tomography images. Patients were divided into two groups based on the severity of rotational deformities. Predictive factors were evaluated using univariate and multivariate regression analyses. Lesser trochanter fragments were significantly associated with large rotational deformities (P < 0.001). Among patients in the large deformity group (>9°), 65.0 % had lesser trochanter fragments; however, among patients in the small deformity group (≤9°), only 10.0 % had lesser trochanter fragments. Other factors such as age, sex, operative time, and blood loss were not significantly different between the severe deformity and minor deformity groups. The presence of lesser trochanter fragments was an independent predictor of the absolute value of rotational deformity (P < 0.001) CONCLUSION: The presence of lesser trochanter fragments is a critical risk factor for postoperative rotational deformities. In such cases, visual landmarks are compromised; therefore, we recommend using objective intraoperative verification techniques rather than relying solely on the lesser trochanter shape sign to prevent malalignment.
Real-time ultrasound monitoring of muscle architecture changes during dynamic contractions is gaining traction as a practical tool for neuromuscular functional assessment. This study aimed to assess the muscle thickness (MT) and deformation velocity of rectus femoris (RF) for predicting muscle strength capacity, evaluating their predictive validity and clinical feasibility. Twenty-three elderly individuals with knee osteoarthritis (KOA) were examined. The thickness of the muscle at rest (MTrest) and at maximal voluntary isometric contraction (MTcontraction), the velocity from rest state to maximum contraction (Velocityactivation) and the velocity from maximal contraction to rest state (Velocityrelaxation) were obtained by M-mode ultrasound. Maximum flexor and extensor strength were measured using an isokinetic dynamometer, the gold-standard assessment tool. MTrest and MTcontraction were significantly correlated with extension strength, also showed correlations with flexion strength. Velocityactivation correlated significantly with both strength (extension: r = 0.742; flexion: r = 0.707). Velocityactivation, but not MT, remained a statistically significant predictor of both extension and flexion strength in multivariate regression models (extension: adjusted R2 = 0.381; flexion: adjusted R2 = 0.314). The deformation of RF, as measured by M-mode ultrasound, provides a visualization method for assessing extension and flexion strength. Velocityactivation showed a significant correlation with both extension and flexion strength. Furthermore, it improved the prediction of thigh muscle strength beyond muscle thickness (MT) alone. Assessing the deformation of RF by M-mode ultrasound may be valuable for detecting alterations in muscle strength and function throughout the disease process in individuals with knee osteoarthritis (KOA).
Valgus-impacted and nondisplaced femoral neck fractures in older adults are commonly treated with cannulated screw fixation. However, the optimal timing for initiating postoperative weight-bearing remains controversial. This study aimed to compare immediate weight-bearing (IWB) as tolerated versus delayed weight-bearing (DWB) to determine whether IWB could improve patient outcomes without increasing the risk of surgical complications. A total of 136 patients aged 65 years or older with valgus-impacted or nondisplaced femoral neck fractures treated using three cannulated screws were retrospectively analyzed. The patients were divided into two groups: the IWB group, which began weight-bearing on the first postoperative day and the DWB group, which started weight-bearing six weeks after surgery. All patients were followed for a minimum of 12 months. Outcome measures consisted of surgical complications, perioperative complications, postoperative length of hospital stay (LOS), and functional recovery evaluated with the Modified Barthel Index (MBI) and the Harris Hip Score (HHS). No significant differences were observed in surgical complications between the two groups. The IWB group had a lower overall perioperative complication rate (6.2 % vs. 18.1 %, p = 0.035) and shorter postoperative LOS (4.9 ± 1.6 vs. 5.6 ± 1.9 days, p = 0.028) than the DWB group. The MBI and HHS were higher in the IWB group at 1 and 3 months postoperatively, while the differences were not statistically significant at 6 and 12 months. For older patients with valgus-impacted or nondisplaced femoral neck fractures, immediate weight-bearing as tolerated following cannulated screw fixation may have a positive effect on reducing perioperative complications, shortening postoperative LOS, and promoting early functional recovery, without increasing surgical complications.
This letter comments on a 10-year follow-up study of patients with lumbar disc herniation treated with intradiscal condoliase in a phase III programme, with attention to long-term effectiveness, safety, imaging changes, and interpretive limitations. We critically appraised the reported long-term clinical and imaging outcomes, focusing on participant retention, missing data, interpretation of structural disc changes, assessment of pain and disability, reintervention reporting, and causal framing in the absence of a long-term comparator. The study provides valuable long-term data, with generally low disability among consenting participants and limited lumbar operations at the injected level. However, less than half of the originally treated cohort contributed long-term follow-up data, raising concerns about selection bias, survivorship bias, and nonrandom missingness. Interpretation is further limited by nonmonotonic imaging follow-up, binary pain assessment at 10 years, limited linkage between imaging progression and patient-centred outcomes, and unclear alignment between instability definitions and longitudinal change. Progressive disc height loss, Modic change, and Pfirrmann progression require cautious interpretation without clearer symptom correlation and stratified analyses. The 10-year follow-up contributes important evidence on condoliase-treated lumbar disc herniation, but stronger handling of missing data, clearer reporting of time to surgery and reasons for reintervention, imaging symptom linkage, and more explicit causal framing would improve interpretability. These refinements would better guide clinicians and patients discussing long-term durability, reintervention risk, and the clinical meaning of progressive imaging change after intradiscal condoliase.