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Objectives: To investigate the knowledge and practices of Chinese doctors in the management of osteoporotic fractures after the Chinese osteoporotic fracture guidelines update and aseries of medical education in 2017. Methods: This was a cross‐sectional survey of doctors in 71 cities across Mainland China. Based on the 2017 Chinese guidelines for the diagnosis and treatment of osteoporotic fractures, a questionnaire was designed and pre‐tested for reliability and validity. Doctors were surveyed with the questionnaire after scientific meetings during February 2017 to January 2018 through WeChat or conference digital platforms or in paper form. Descriptive statistics was used to analyze the responses to the questionnaire. Results: Overall, 314 valid questionnaires were confirmed. Regarding diagnosis, 77% agreed that osteoporosis could be diagnosed once an osteoporotic fracture occurred; 83% believed that the bone mineral density criteria for osteoporosis diagnosis would be T ≤ −2.5 SD. For treatment, almost all (99.7%) agreed with anti‐osteoporosis treatment being one of the basic principles of osteoporotic fracture treatment; 71.6% considered bisphosphonates as the most commonly used anti‐osteoporosis drug; 97% believed that patients who have used anti‐osteoporosis drugs should reassess osteoporosis after osteoporotic fractures instead of discontinue; 95% thought that the patients who did not use anti‐osteoporosis medications before osteoporotic fracture should be treated with anti‐osteoporosis drugs after fracture treatment as early as possible; 89% agreed that the standard use of bisphosphonates after osteoporotic fracture would not affect bone healing adversely; 59% believed the course of bisphosphonates treatment for osteoporosis would be 3–5 years, and 27% considered it to be 1–3 years. The patient follow‐up rate was poor: 46% selected follow‐up rate <30%; only 20% selected follow‐up rate >50%. Only 31% of the hospitals had long‐term management programs for osteoporotic fractures. Conclusions: Doctors generally adhered to the updated Chinese guidelines for osteoporotic fractures; frequent participation in medical education can help doctors to increase their awareness of osteoporosis as well as their acceptance and practice of the guidelines. [ABSTRACT FROM AUTHOR]

Osteoporosis (OP) is a systemic metabolic bone disease that is characterized by decreased bone mineral density and microstructural damage to bone tissue. Recent studies have demonstrated significant advances in the research of programmed cell death (PCD) in OP. However, there is no bibliometric analysis in this research field. This study searched the Web of Science Core Collection (WoSCC) database for literature related to OP and PCD from 2000 to 2023. This study used VOSviewers 1.6.20, the "bibliometrix" R package, and CiteSpace (6.2.R3) for bibliometric and visualization analysis. A total of 2905 articles from 80 countries were included, with China and the United States leading the way. The number of publications related to PCD in OP is increasing year by year. The main research institutions are Shanghai Jiao Tong University, Chinese Medical University, Southern Medical University, Zhejiang University, and Soochow University. Bone is the most popular journal in the field of PCD in OP, and the Journal of Bone and Mineral Research is the most co‐cited journal. These publications come from 14,801 authors, with Liu Zong‐Ping, Yang Lei, Manolagas Stavros C, Zhang Wei, and Zhao Hong‐Yan having published the most papers. Ronald S. Weinstein was co‐cited most often. Oxidative stress and autophagy are the current research hot spots for PCD in OP. This bibliometric study provides the first comprehensive summary of trends and developments in PCD research in OP. This information identifies the most recent research frontiers and hot directions, which will provide a definitive reference for scholars studying PCD in OP. [ABSTRACT FROM AUTHOR]

The knee is the most complex joint in the human body, including bony structures like the femur, tibia, fibula, and patella, and soft tissues like menisci, ligaments, muscles, and tendons. Complex anatomical structures of the knee joint make it difficult to conduct precise biomechanical research and explore the mechanism of movement and injury. The finite element model (FEM), as an important engineering analysis technique, has been widely used in many fields of bioengineering research. The FEM has advantages in the biomechanical analysis of objects with complex structures. Researchers can use this technology to construct a human knee joint model and perform biomechanical analysis on it. At the same time, finite element analysis can effectively evaluate variables such as stress, strain, displacement, and rotation, helping to predict injury mechanisms and optimize surgical techniques, which make up for the shortcomings of traditional biomechanics experimental research. However, few papers introduce what material properties should be selected for each anatomic structure of knee FEM to meet different research purposes. Based on previous finite element studies of the knee joint, this paper summarizes various modeling strategies and applications, serving as a reference for constructing knee joint models and research design. [ABSTRACT FROM AUTHOR]

Background: Lumbar spondylolysis is a common cause of low back pain in adolescents. A lot of adolescent idiopathic scoliosis with concomitant spondylolysis has been reported before, but only two cases with acquired spondylolysis following long fusion for scoliosis were reported. We described another similar rare case and discussed its causes and treatment options in this paper. Case Presentation: A 17‐year‐old female underwent growing rod implantation, growing rod extension, and final long spinal fusion for idiopathic scoliosis. Then, she suffered from low back pain with a VAS of 1‐2 points and gradually aggravated to a VAS of 7‐8 points at 3.5 years after the final fusion. The X‐ray images showed that there was L4‐S1 instability. And the CT scan images showed new bilateral spondylolysis of L5. Conclusions: These findings suggested that distal mechanical stress might cause spondylolysis of the distal vertebra following long fusion for scoliosis. Surgeons should keep instrumentation as short as possible and avoid choosing a low lumbar as LIV when they decide on the fusion levels. [ABSTRACT FROM AUTHOR]

Objective: The revision procedure for failure of internal fixation after thoracolumbar fracture is controversial. Combined anterior and posterior surgery is associated with higher risk more intraoperative bleeding and tissue damage. The success rate of simple anterior surgery needs further confirmation, and posterior surgery lacks stability of internal fixation. This study evaluates the feasibility and surgical effect of multi‐rod constructs in the revision of thoracolumbar fractures. Methods: Eleven patients with thoracolumbar fractures who underwent previous construct failure and were treated with revision and internal fixation with the multi‐rod technique from March 2017 to September 2018 were analyzed. The original internal fixation was removed and replaced in the medial insertion of satellite rods and bone graft. The average follow‐up time was 15.97 months. The intraoperation blood loss, the time of the operation, activation and discharge and the rate of rod fracture were calculated. The sagittal Cobb angle before revision, after revision and at the last follow‐up were compared. The clinical effect was evaluated by visual analogue scale (VAS) and Oswestry Disability Index questionnaire (ODI). Results: The average operation time was 107 min, the intraoperative blood loss was 131.81 mL, the active time was 1.59 days, and the discharge time was 10.89 days. No rod fractured again during the follow‐up period. The paired t‐test was used to compare the Cobb angle, VAS score, and ODI before and after surgery. There was significant difference in the sagittal Cobb angle between the pre‐revision and the posterior sagittal position (p = 0.000), and no significant difference was found between post‐revision and last follow‐up (p = 0.551). VAS and ODI were greatly improved at the last follow‐up. Conclusion: The literature on revision of thoracolumbar fractures is insufficient and comprises varying opinions. This paper proposes a new treatment option. The application of the multi‐rod constructs in the revision of thoracolumbar fractures is safe, simple, and effective and might provide guidance for future clinical work. [ABSTRACT FROM AUTHOR]

Periprosthetic femoral fractures (PPFFs) following total hip arthroplasty (THA) present a significant clinical challenge due to their increasing incidence with an aging population and evolving surgical practices. Historically, classifications were primarily based on anatomical fracture location, the stability of the implant, and bone quality surrounding the implant. We critically analyzed 25 classification systems, highlighting the emergence and adaptations of key systems such as the Vancouver classification system (VCS) and the Unified classification system (UCS), which are lauded for their simplicity and effectiveness yet require further refinement. VCS, developed in 1995, categorizes fractures based on the site, implant stability, and bone quality, and remains widely used due to its robust applicability across different clinical settings. Introduced in 2014, UCS expands the VCS to encompass all periprosthetic fractures with additional fracture types, aiming for a universal application. Despite their widespread adoption, these systems exhibit shortcomings, including the incomplete inclusion of all PPFF types and the imprecise assessment of implant stability and surrounding bone loss. These gaps can result in misclassification and suboptimal treatment outcomes. This paper suggests the necessity for ongoing improvements in classification systems to include emerging fracture types and refined diagnostic criteria, ensuring that they remain relevant to contemporary orthopedic practices and continue to facilitate the precise tailoring of treatment to patient‐specific circumstances. This comprehensive historical review serves as a foundation for future innovations in classification systems, ultimately aiming to standardize PPFF treatment and improve patient prognosis. [ABSTRACT FROM AUTHOR]

The study aimed to make a bibliometric analysis of the current research situation in unilateral biportal endoscopy/biportal endoscopic spinal surgery (UBE/BESS). Research data sets were acquired from the Web of Science database. The study chosed "biportal endoscopic spinal surgery" OR "two portal endoscopic spinal surgery" OR "percutaneous biportal endoscopic decompression" OR "unilateral biportal endoscopy" OR "irrigation endoscopic discectomy" as the search terms. The literature search was limited to articles published before March 5, 2021. We only included original articles and reviews. VOS viewer and Citespace software were used to analyze the data and generate visualization knowledge maps. Annual trend of publications, distribution, H‐index status, co‐authorship status, and research hotspots were analyzed. A total of 74 publications met the requirement. The sum number of citations was 31,204, in which 19,336 were no self‐citations. The average citation of all the papers was 21.84 times. The H‐index of all the publications was 85. South Korea's total number of articles was far higher than that of other countries and regions (61, 82.4%), followed by United Arab Emirates, Egypt, and Peoples Republic of China (three, ranking second, accounting for 12.2% of the total). For the most productive authors, Choi ranked first with 21 articles, Kim ranked second with 16 articles, and Heo ranked third with 12 articles. The journal with the greatest number of publications was World Neurosurgery, with a total of 18 (39.1%) papers. Clinics in Orthopedic Surgery ranked second with six (13.0%) papers. In third place, there were fix articles published by Asian Spine Journal and Neurospine, accounting for 21.8% of the total articles. These top three journals accounted for 73.9% of all the papers. Spondylolisthesis and endoscopic decompression were the research hotspots in recent years. The number of publications has showed an upward trend with a stable rise in recent years. South Korea is the country with the highest productivity, not only in quality, but also in quantity. Barun Hosp and Leon Wiltse Mem Hosphave published most articles. Choi is the most productive author. World Neurosurgery is the most productive journal. Spondylolisthesis and endoscopic decompression are the research hotspots in recent years. Indeed, this study provides new insight into the growth and development of UBE/BESS. [ABSTRACT FROM AUTHOR]

Objective: To explore the development of hip arthroscopy in China through reviewing the change of the application of hip arthroscopy operation on treating femoracetabular impingement (FAI). Method: Papers were retrieved from January 1, 2005 to November 1, 2019, from databases CNKI, Wanfang Data, VIP, PubMed, and Embase. The keywords are Hip Impingement, Femoroacetabular impingement, Hip arthroscopy, Arthroscopic operation, Hip Arthroscopy operation, and Arthroscope, etc. The quality of papers was assessed through MINORS , and statistics and meta‐analysis were performed by Word, Excel, and Revman 5.3 Zurich, Switzerland. Results: From a total of 8,953 papers, 46 review articles without data and 48 articles with data were involved, and 25 papers were included in the Meta‐analysis. The twenty‐five papers were selected from 48 papers with data, of which 41 were reported in Chinese, 11 were missing complete Harris scores, five did not mention the number of patients who had lost follow‐up, three had minors quality scores below 7, one did not have enough FAI cases, and three did not have standard deviations in Harris scores. Overall, in China, the application of hip arthroscopy regarding FAI has flourished while maintaining a high level of treatment and has reached its peak in the past 2 years. Conclusion: With the rapid development of hip arthroscopy in China, hip operation is widely recognized, many reports on its application on FAI have emerged successively, and the scope of application and technical level have been improved. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is a common surgery for osteoarthritis, with increasing prevalence expected in the near future. This systematic review and meta‐analysis compared the effectiveness of computerized TKA versus traditional TKA, focusing on postoperative outcomes measured by the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the Knee Society score (KSS). A search on PubMed and Cochrane databases on November 14, 2023 for retrospective randomized controlled trials (RCTs) yielded data on WOMAC and KSS. The search strategy was predefined, and methodological quality of studies was critically appraised. Two researchers extracted data. Unpaired t‐testing assessed the mean monthly changes in KSS and WOMAC for computer‐aided versus traditional TKA. Review Manager 5.3 was used for data synthesis and analysis. Out of 729 records, five RCTs enrolling 339 patients were eligible and analyzed using a random effects meta‐analysis. The mean monthly ΔKSS score differed significantly between the traditional and computerized groups (11.47 ± 8.76 vs. 9.26 ± 6.05, respectively; p < 0.01). However, the pooled mean difference estimate showed no significant differences (D = 0.20, 95% CI = −0.53 to 0.93, p = 0.59), with high heterogeneity (I2 = 85%, p < 0.001). The mean monthly ΔWOMAC score also differed significantly (−14.18 ± 21.54 vs. −18.43 ± 20.65, respectively; p < 0.05), but again, no significant differences were found in the pooled estimate (D = 0.17, 95% CI = −0.46 to 0.79, p = 0.60), with moderate heterogeneity (I2 = 28%, p = 0.24).There is no significant difference in KSS or WOMAC outcomes between traditional and computerized TKA. The study suggests the need for further research with longer follow‐up periods, more timepoints, and a broader range of patient outcome measures to fully evaluate the advantages and disadvantages of each method. [ABSTRACT FROM AUTHOR]

Objective: S2 alar‐iliac (S2AI) screw had been widely used in the pelvic fusion for degenerative lumbar scoliosis (DLS) patients. However, whether S2AI screw trajectory was influenced by sagittal profile in DLS patients had not been comprehensively investigated. The objective of this study was to evaluate the associations between the optimal S2 alar‐iliac (S2AI) screw trajectory and sagittal spinopelvic parameters in DLS patients. Methods: Computed tomography (CT) scans of pelvis were performed in 47 DLS patients for three‐dimensional reconstruction of S2AI screw trajectory from September 2019 to November 2021. Five S2AI screw trajectory parameters were measured in CT reconstruction images, including: 1) angle in the transverse plane (Tsv angle); 2) angle in the sagittal plane (Sag angle); 3) maximal screw length; 4) screw width; and 5) skin distance. The lumbar Cobb angle, lumbar apical vertebral translation (AVT); global kyphosis (GK); thoracic kyphosis (TK); lumbar lordosis (LL); sagittal vertical axis (SVA); sacral slope (SS); pelvic tilt (PT); and pelvic incidence (PI) were measured in standing X‐ray films of the whole spine and pelvis. Results: Both Tsv angle and Sag angle had significant positive associations with SS (p < 0.05) but negative associations with both PT (p < 0.05) and LL (p < 0.05) in all cases. Patients with SS less than 15° had both smaller Tsv angle and Sag angle than those with SS equal to or more than 15° (p < 0.05). The decreased LL would lead to the backward rotation of the pelvis, resulting in a more cephalic and less divergent trajectory of S2AI screw in DLS patients. Conclusions: For DLS patients with lumbar kyphosis, spine surgeons should avoid both excessive Tsv and Sag angles for S2AI screw insertion, especially when using free‐hand technique. [ABSTRACT FROM AUTHOR]

Objective: Medial opening‐wedge high tibial osteotomy (MOWHTO) is a surgical procedure to treat medial compartment osteoarthritis in the knee with varus deformity. However, factors such as patellar height (PH) and the sagittal plane's posterior tibial slope angle (PTSA) are potentially overlooked. This study investigated the impact of alignment correction angle guided by computer‐designed personalized surgical guide plate (PSGP) in MOWHTO on PH and PTSA, offering insights for enhancing surgical techniques. Methods: This retrospective study included patients who underwent 3D‐printed PSGP‐assisted MOWHTO at our institution from March to September 2022. The paired t‐tests assessed differences in all preoperative and postoperative measurement parameters. Multivariate linear regression analysis examined correlations between PTSA, CDI (Caton–Deschamps Index), and the alignment correction magnitude. Receiver operating characteristic (ROC) curve analysis determined the threshold of the correction angle, calculating sensitivity, specificity, and area under the curve. Results: A total of 107 patients were included in our study. The CDI changed from a preoperative mean of 0.97 ± 0.13 (range 0.70–1.34) to a postoperative mean of 0.82 ± 0.13 (range 0.55–1.20). PTSA changed from a preoperative mean of 8.54 ± 2.67 (range 2.19–17.55) to a postoperative mean of 10.54 ± 3.05 (range 4.48–18.05). The t‐test revealed statistically significant changes in both values (p < 0.05). A significant alteration in patellar height occurred when the correction angle exceeded 9.39°. Moreover, this paper illustrates a negative correlation between CDI change and the correction angle and preoperative PTSA. Holding other factors constant, each 1‐degree increase in the correction angle led to a 0.017 decrease in postoperative CDI, and each 1‐degree increase in preoperative PTSA resulted in a 0.008 decrease in postoperative CDI. PTSA change was positively correlated only with the correction angle; for each 1‐degree increase in the opening angle, postoperative PTS increased by 0.188, with other factors constant. Conclusion: This study highlights the effectiveness and precision of PSGP‐assisted MOWHTO, focusing on the impact of alignment correction on PH and PTSA. These findings support the optimization of PSGP technology, which offers simpler, faster, and safer surgeries with less radiation and bleeding than traditional methods. However, PSGP's one‐time use design and the learning curve required for its application are limitations, suggesting areas for further research. [ABSTRACT FROM AUTHOR]

Chordoma is a rare tumor, but has a serious effect on the quality of life of patients. This study aims to assess the overall knowledge structure and trends in the development of chordoma research using a bibliometric analysis and visualization tool. Research datasets were acquired from the Web of Science. VOS viewer and CiteSpace visualization software were used to demonstrate collaborations and correlations. Annual trends in publications, distribution, H‐index status, co‐authorship status, and research hotspots were analyzed. A total of 1844 publications from 2012 to 2022 were included. The number of chordoma‐related publications increased year by year. The United States contributed the most publications (717) and had the highest total citations (10130) and H‐index (50), followed by China. The United States was also the country most frequently involved in international cooperation. The most productive organization involved in chordoma research was Massachusetts General Hospital. World Neurosurgery (114) published the most papers on chordoma. Hornicek FJ was the most productive author over the last decade (41). Initially, diagnosis and the location of onset captured the attention of the research society. Quality of life, risk factors, disability, minimally invasive surgical techniques, molecular targeted therapy, and radiotherapy technology are the research hotspots in recent years. Indeed, this study provides important insights into the overall landscape of chordoma research and also contributes to the further investigation of the international frontier of chordoma. [ABSTRACT FROM AUTHOR]

Objectives: There is no clear consensus so far on which fixation method is most favorable for the tibial tunnel in anterior cruciate ligament reconstruction (ACLR). The purpose of this paper is to investigate the outcome of RigidFix cross pins fixation in the tibial tunnel and to explore the advantages of RigidFix applied both in the femoral and tibial tunnel with hamstring tendon graft in anterior cruciate ligament reconstruction. Methods: This retrospective study included 53 patients (male/female, 45/8) who underwent anterior cruciate ligament reconstruction using autologous hamstring tendons between January 2013 and December 2017 at our institute. The participants in group A (n = 36) received anterior cruciate ligament reconstruction with RigidFix cross pins fixation in both femoral and tibial tunnels, while those in group B (n = 17) with RigidFix cross pins fixation in the femoral tunnel and Interference screw fixation in the tibial tunnel. The visual analogue scale (VAS) score, International Knee Documentation Committee subjective knee form 2000 (IKDC2000) score, Lysholm knee scoring scale, Tegner activity score and the side‐to‐side difference were compared at 2 and 5 years postoperatively. The graft diameter, number of strands in graft and the average diameter of each strand were also compared between the two groups. The categorical parameters were analyzed by chi‐square test and the continuous variables conforming to a normal distribution were analyzed by Student's t‐test. Results: At 2 years postoperation, the VAS score (1.61 ± 0.55), side‐to‐side difference (1.50 ± 0.58) in group A were significantly lower than that in group B, and the IKDC2000 score (88.81 ± 3.88), Tegner activity score (6.14 ± 0.60) in group A were significantly higher than that in group B. At 5 years postoperation, the VAS score (1.64 ± 0.68), side‐to‐side difference (1.73 ± 0.63) in group A were significantly lower than that in group B, and the IKDC2000 score (89.09 ± 3.85), Tegner activity score (6.58 ± 0.94) in group A were slso significantly higher than that in group B. There was statistical difference in the change of the side‐to‐side difference between the two groups (group A vs. B, 0.22 ± 0.08 vs. 0.34 ± 0.11, p < 0.001). There were also statistical differences in the graft diameter (group A vs. B, 7.83 ± 0.74 vs. 7.41 ± 0.51, p = 0,038), number of strands in graft (5.67 ± 0.72 vs. 4.00 ± 0.00, p < 0.001) and the average diameter of each strand (1.41 ± 0.22 vs. 1.85 ± 0.13, p < 0.001) between the two groups. Conclusion: RigidFix cross pins fixation in the tibial tunnel for anterior cruciate ligament reconstruction can achieve better 5‐year results when compared with the interference screw, and the hamstring tendon can be folded into a thicker graft when RigidFix cross pins were applied in both femoral and tibial tunnels. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions Trial Registration Plate fixation is the preferred method for treating forearm shaft fractures. However, it remains controversial regarding the necessity of implant removal after bone union. This review aims to assess refracture risk after plate removal.We searched various data sources, including PubMed, Embase, Web of Science, and Cochrane Library. A total of 6749 papers were identified, of which 23 studies were eligible for final quantitative syntheses. Subgroup analyses and sensitivity analyses were conducted to reduce heterogeneity and make the results more reliable.The total risk difference (RD) was 0.06 (0.04–0.09), indicating that the difference was significant. In the “Reasons for Removal” subgroup analysis, the RD of the “No Symptom” subgroup was 0.07 (95% CI = 0.04–0.11), while the RD of the “Symptoms” subgroup was 0.04 (95% CI = −0.02 to 0.10). In the “Plate Type” subgroup analysis, the RD of the “LCP” subgroup was 0.07 (95% CI = 0.02–0.13), while the RD of the “DCP” subgroup was 0.07 (95% CI = 0.01–0.13). After omitting each study one by one, the RDs were all significant.Plate retention is significantly associated with a lower rate of refracture than plate removal. Consequently, it is not recommended to remove implants, especially for patients without implant‐related symptoms, but more reliable evidence is still needed.The review was registered on PROSPERO and the registration ID is CRD42023424743, and a protocol was not prepared [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion Patients with osteoporotic vertebral compression fractures (OVCF) treated with vertebroplasty (PVP) are experiencing an increasing number of problems such as pain recurrence, mainly due to recompression fractures of the operated vertebral body within a certain period of time after the operation, which is closely related to the distribution of intraoperative bone cement. The aim of this study is to investigate the effect of different spacing distributions between the upper boundary of the cement and the upper endplate of the operated vertebra on the biomechanics of the operated vertebra after percutaneous vertebroplasty for OVCF using finite element analysis (FEA).One patient with L1 vertebral body OVCF was selected, and computed tomography (CT) of the thoracolumbar segment was performed. The CT data were extracted to establish an FEA model of the T12–L2 vertebral bodies. Bone cement was injected into the L1 vertebral body. Based on the spacing between the upper boundary of the bone cement and the vertebral body's upper endplates, the model vertebrae were divided into 0, 2, 4, and 6 mm spacing groups, and the human body's upright, flexion–extension, lateral flexion, and rotational positions were simulated. The biomechanical effects of different spacing distributions on the postoperative L1 vertebral body and the injected bone cement were evaluated.In this paper, we found that the Von Mises stress of the L1 vertebrae was the smallest when the spacing between the upper boundary of the bone cement and the vertebral body's upper endplates was 0 mm. The larger the spacing in a certain range between the upper boundary of the bone cement and the vertebral body's upper endplates, the greater the Von Mises stress of the L1 vertebrae. However, in the stress comparison of the injected bone cement, the Von Mises stress of the bone cement was greatest when the spacing between the upper boundary of the bone cement and the upper endplate of the vertebral body was 0 mm; the larger the spacing, the smaller the Von Mises stress.When the contact spacing between the upper boundary of the bone cement and the upper endplate of the vertebral body is 0 mm, it can effectively eliminate and transfer the pressure caused by the load, thus reducing the stress on the cancellous bone and further reducing the risk of vertebral refracture after surgery. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose Methods Results Conclusions Infection after fracture fixation (IAFF) is a severe complication. There are few multicenter studies targeting IAFF. This paper identifies independent risk factors associated with IAFF by analyzing multicenter clinical data. Appropriate interventions should be implemented to reduce the risk of IAFF.This is a multicenter retrospective cohort study. This study screened medical records of patients who underwent internal fixation for fractures at participating medical institutions from January 1, 2011, to December 31, 2020. Data extraction included demographic characteristics, disease features, surgical variables, and laboratory indicators. Logistic regression analysis was employed to identify the relationship between relevant risk factors and IAFF. Research data were sourced from the hospital's electronic medical record system and self‐constructed databases.In our study, 202 patients who underwent internal fixation for fractures experienced postoperative infections, which corresponds to an overall incidence rate of approximately 1.7%. The predominant pathogen identified in these infections was Staphylococcus aureus. A multifactorial analysis indicated that several factors were independently associated with the occurrence of IAFF. These factors included BMI ranges of 24.0–27.9 and 28.0–31.9, smoking, a high ASA score, high‐energy trauma, diabetes, open fracture, seasonal timing of the surgery (summer), bone grafting, drainage duration, surgical duration ≥ 180 min, and A/G ratio < 1.2.We strongly recommend that orthopedic surgeons perform comprehensive preoperative assessments on fracture patients to identify factors that may increase the risk of infection. Through the implementation of targeted interventions and beneficial modifications to these modifiable risk factors, it is possible to lower the incidence of IAFF. Additionally, proactive screening, risk stratification, and thorough patient education should be prioritized for patients with high risk but nonmodifiable factors. [ABSTRACT FROM AUTHOR]

Objective: Intertrochanteric fracture is a very common but serious type of hip fracture in nonagenarians. The surgical treatment remains a significant challenge for orthopedists. The objective of this study was to investigate postoperative complications and survival outcomes compared between bipolar hemiarthroplasty (HA) and proximal femoral nail anti‐rotation (PFNA) in nonagenarians with intertrochanteric fractures, and to evaluate the efficacy and safety of the two surgical procedures in this patient population. Methods: A total of 113 consecutive nonagenarians who underwent bipolar HA or PFNA for the treatment of intertrochanteric fractures from January 2006 to August 2021 were retrospectively studied in the current paper. There were 34 males and 79 females, with a mean age of 92.2 years (range 90–101 years) at the time of operation. The average duration of follow‐up was 29.7 months (range 1–120 months). The full cohort was divided into bipolar HA (77 cases) and PFNA (36 cases) groups. Damage control orthopedics was used to determine the optimal surgery time and assist in perioperative management. A restrictive blood transfusion strategy was employed, along with appropriate adjustments under multidisciplinary assessment, throughout the perioperative period. Perioperative clinical information and prognostic data were analyzed. Kaplan–Meier survival curves were used for survival analysis, and landmark analysis divided the entire follow‐up period into 1–12 months (short‐term), 13–42 months (medium‐term) and 43–120 months (long‐term) according to the configurations of Kaplan–Meier survival curves. Results: Both groups had similar general variables except for the proportion of high adjusted Charlson comorbidity index (aCCI) (≥6 points) (6.5% in bipolar HA group and 22.2% in PFNA group, p = 0.024). Intraoperative blood loss and transfusion requirements were greater, and the intraoperative transfusion rates were higher in the bipolar HA group compared to the PFNA group (all p < 0.05). The complications rates, 1‐ to 60‐month cumulative all‐cause mortality, postoperative optimal Harris hip score (HHS), and Barthel index (BI) presented no significant difference between the two groups (all p > 0.05). Both groups had similar overall survival curves (p = 0.37). However, landmark analysis revealed that bipolar HA group exhibited higher survival rates in medium‐term (p = 0.01), while similar survival rates were observed in the short‐ and long‐term post‐operation periods (both p > 0.05). Cox regression with survival‐time‐dependent covariate calculated the hazard ratio (HR) of bipolar HA was 0.41 in medium‐term (p = 0.039). Conclusion: Bipolar HA is equally effective and reliable as PFNA for treating intertrochanteric fractures in nonagenarians. Despite resulting in more intraoperative blood loss and transfusions, bipolar HA therapy is associated with a higher medium‐term survival rate compared to PFNA treatment. The application of damage control orthopedics and precise perioperative patient blood management could contribute to the positive clinical outcomes observed in this patient population. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) causes disability and significant economic and social burden. Cartilage injury is one of the main pathological features of OA, and is often manifested by excessive chondrocyte death, inflammatory response, abnormal bone metabolism, imbalance of extracellular matrix (ECM) metabolism, and abnormal vascular or nerve growth. Regrettably, due to the avascular nature of cartilage, its capacity to repair is notably limited. Mesenchymal stem cells‐derived extracellular vesicles (MSCs‐EVs) play a pivotal role in intercellular communication, presenting promising potential not only as early diagnostic biomarkers in OA but also as efficacious therapeutic strategy. MSCs‐EVs were confirmed to play a therapeutic role in the pathological process of cartilage injury mentioned above. This paper comprehensively provides the functions and mechanisms of MSCs‐EVs in cartilage repair. [ABSTRACT FROM AUTHOR]

Objective: To perform a bibliometric analysis of research on articular cartilage repair published in Chinese and English over the past decade. Fundamental and clinical research topics of high interest were further comparatively analyzed. Methods: Relevant studies published from 1 January 2009 to 31 December 2018 (10 years) were retrieved from the Wanfang database (Chinese articles) and six databases, including MEDLINE, WOS, INSPEC, SCIELO, KJD, and RSCI on the website "Web of Science" (English articles), using key words: "articular cartilage" AND "injury" AND "repair". The articles were categorized according to research focuses for a comparative analysis between those published in Chinese vs English, and further grouped according to publication date (before and after 2014). A comparative analysis was performed on research focus to characterize the variation in research trends between two 5‐year time spans. Moreover, articles were classified as basic and clinical research studies. Results: Overall, 5762 articles were retrieved, including 2748 in domestic Chinese journals and 3014 in international English journals. A total of 4937 articles focused on the top 10 research topics, with the top 3 being stem cells (32.1%), tissue‐engineered scaffold (22.8%), and molecular mechanisms (16.4%). Differences between the numbers of Chinese and English papers were observed for 3 topics: chondrocyte implantation (104 vs 316), osteochondral allograft (27 vs 86), and microfracture (127 vs 293). The following topics gained more research interest in the second 5‐year time span compared with the first: microfracture, osteochondral allograft, osteochondral autograft, stem cells, and tissue‐engineered scaffold. Articles with a focus on three‐dimensional‐printing technology have shown the fastest increase in publication numbers. Among 5613 research articles, basic research studies accounted for the majority (4429), with clinical studies described in only 1184 articles. The top 7 research topics of clinical studies were: chondrocyte implantation (28.7%), stem cells (21.9%), microfracture (19.2%), tissue scaffold (10.6%), osteochondral autograft (10.5%), osteochondral allograft (6.3%), and periosteal transplantation (2.8%). Conclusion: Studies focused on stem cells and tissue‐engineered scaffolds led the field of damaged articular cartilage repair. International researchers studied allograft‐related implantation approaches more often than Chinese researchers. Traditional surgical techniques, such as microfracture and osteochondral transplantation, gained high research interest over the past decade. [ABSTRACT FROM AUTHOR]

Objective: Conventional open internal fixation surgery for thoracolumbar fractures has many complications and long recovery time. There are few clinical studies on the minimally invasive percutaneous injured vertebrae screw internal fixation. The purpose of this paper is to evaluate the application value of minimally invasive percutaneous injured vertebrae screw internal fixation in the treatment of thoracolumbar fractures (TF). Methods: A total of 98 patients with TF admitted to our hospital from January 2019 to December 2021 were retrospectively enrolled. According to the surgical method, the patients were divided into the study group (n = 49, treated with minimally invasive percutaneous injured vertebrae screw internal fixation) and the control group (n = 49, treated with traditional open internal fixation surgery). The two groups were compared in the perioperative period, the degree of pain at different periods, the percentage of the height of the anterior edge of the injured vertebra, the Cobb angle of the injured vertebra body and the wedge angle of the injured vertebra body at the first week and the last follow‐up, and the postoperative complications and the occurrence of the cone shell after the operation were recorded. Then, statistical analysis such as Student's t test or Chi‐Square test was performed. Results: The operation time (p = 0.002), intraoperative blood loss (p < 0.001), postoperative drainage volume (p = 0.011), and length of hospital stay (p = 0.003) in the study group were significantly lower than that in the control group. The VAS in the study group (3.38 ± 1.02) was significantly lower than that in the control group (4.56 ± 1.04) on the 7th day after the operation, with a significant difference (p < 0.001). The correction values of the percentage of leading edge height (LEH), Cobb angle, wedge angle in the study group were significantly lower than that in the control group at 1 week after surgery (all ps < 0.001). The incidence of postoperative complications in the study group (one case, 2.04%) was significantly lower than that in the control group (seven cases, 14.29%) (p = 0.031). At 1 month, 6 months, 10 months, and the last follow‐up, the incidence of "empty shell" on CT scan in the study group were lower than that in the control group with a significant difference (all ps < 0.05). Conclusion: Applying minimally invasive percutaneous injured vertebrae screw internal fixation is more beneficial to shorten the operation time and hospital stay, with fewer postoperative complications. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review to determine the current arthroscopic techniques of the fixation of femoral head and acetabulum fractures and assess the radiological and functional outcomes reported in literature written in English. Methods: This review was performed by searching PubMed, Cochrane Library, Scopus, and Web of Science without a filter for time limitation in line with Preferred Reporting Items for Systematic Reviews Protocols (PRISMA‐P) guidelines. Two authors took part in screening and evaluating the literature between December 2020 and January 2021. The terms acetabulum fracture, reduction, fixation, femur head fracture, fracture dislocation of the hip, hip trauma and arthroscopy or arthroscopic, and their combinations were used to search four database engines in the titles and abstracts of the reported papers. Only papers with English titles and abstracts were included. The assessment of the data related to descriptions of the techniques, indications for fracture fixation using arthroscopy, and patient‐related outcomes. Results: Perfect agreement was detected between the two reviewers during all steps of the review process (κ = 0.81–1.00). Although a meta‐analysis was planned to be carried out, no randomized controlled study comparing either the radiological or functional results of different surgical techniques was detected in the literature. Nineteen studies were included in the study. Of these, 15 were retrospective case reports and four were case series. Twenty‐seven patients were operated on for acetabulum fractures (18 male/nine female). The mean age was 28.3 years (range, 15–53 years). High‐energy traumas including motor vehicle accidents were the most common reason (81%). The duration of follow‐up was a mean of 32 months (range, 12–68 months). Sixteen patients were operated on for femur fractures (12 male/three female). The mean age was 30.1 years (range, 17–50 years). Motor vehicle accident was the most common trauma (70%). Duration of follow‐up had a mean of 18 months (range, 4–60 months). Patient‐related outcomes were excellent for reported cases in both groups despite the fact that an objective scoring system was not used for most of the cases. Moreover, there was no consensus on surgical indications or the techniques. Conclusions: The techniques of arthroscopic‐assisted fixation of acetabulum and femoral head fracture are so heterogeneous that conclusions cannot be made at this time, but there is potential for this method of treatment to become more popular as the devices used in the procedure develop and as exposure to and experience with hip arthroscopy improves. Further descriptions of reduction and fixation techniques and analysis of outcomes of RCTs are needed. [ABSTRACT FROM AUTHOR]

The purpose of this meta‐analysis was to identify if patient‐specific instrumentation (PSI) could increase the accuracy of the correction in high tibial osteotomy (HTO) and to explore the assessment indices and the necessity of using a PSI in HTO. A systematic search was carried out using online databases. A total of 466 patients were included in 11 papers that matched the inclusion criteria. To evaluate the accuracy of PSI‐assisted HTO, the weight bearing line ratio (WBL%), hip‐knee‐ankle angle (HKA), mechanical medial proximal tibial angle (mMPTA), and posterior tibial slope angle (PTSA) were measured preoperatively and postoperatively and compared to the designed target values. Statistical analysis was performed after strict data extraction with Review Manager (version 5.4). Significant differences were detected in WBL% (MD = −36.41; 95% CI: −42.30 to −30.53; p < 0.00001), HKA (MD = −9.95; 95% CI: –11.65 to –8.25; p < 0.00001), and mMPTA (MD = –8.40; 95% CI:−10.27 to −6.53; p < 0.00001) but not in PTSA (MD = 0.34; 95% CI: −0.59 to 1.27; p = 0.47) between preoperative and postoperative measurements. There was no significant difference between the designed target values and the postoperative correction values of HKA (MD = 0.14; 95% CI: −0.19 to 0.47; p = 0.41) or mMPTA (MD = 0.11; 95% CI −0.34 to 0.55; p = 0.64). The data show that 3D‐based planning of PSI for HTO is both accurate and safe. WBL%, HKA, and mMPTA were the optimal evaluation indicators of coronal plane correction. Sagittal correction is best evaluated by the PTSA. The present study reports that PSI is accurate but not necessary in typical HTO. [ABSTRACT FROM AUTHOR]

Objective: Medial opening wedge high tibial osteotomy (HTO) is successful in the treatment of knee osteoarthritis with medial compartment stenosis and tibial varus deformity, but patella infera is the main complication. This study aims to design a new medial tibial open osteotomy scheme, transtibial tuberosity‐high tibial osteotomy (TT‐HTO), which can fully protect the patellar tendon insertion. In addition, the area of the osteotomy surface and wedge volume were evaluated in TT‐HTO, biplanar distal tibial tuberosity osteotomy (biplanar‐DTO), and uniplanar‐DTO to evaluate the potential advantages of this technology in bone healing. Methods: The tibial tubercle was divided into four equal sections from proximal to distal, which were defined as zones A, B, C, and D. From September to December 2020, the imaging examinations of 200 patients (95 males and 105 females) with a mean age of 40.6 years (range 19–60 years) were evaluated to observe the zonation of the tibial tubercle where the insertion of the patellar tendon is located. Then, 59 patients (23 males and 36 females) with a mean age 59.6 years (range 43–77 years), for a total of 69 knees (32 right and 37 left), who underwent routine knee surgery were observed and verified. According to the position of the patellar tendon insertion, TT‐HTO was designed. Fifteen tibial sawbones were divided equally into three groups: TT‐HTO; biplanar‐DTO; and uniplanar‐DTO. The total area of the osteotomy surface was compared using the graph paper method. The wedge volume at wedge heights of 10 mm was compared among osteotomy types using the plasticine Archimedes principle. One‐way repeated‐measures analysis of variance was used to compare the total area of the osteotomy surface and the wedge volume. Results: The osteotomy line of TT‐HTO passes through the boundary point of zones B and C of the tibial tubercle to fully protect the insertion point of the patellar tendon. The total area of the osteotomy surface in TT‐HTO and biplanar‐DTO was significantly larger than that in uniplanar‐DTO (P < 0.05). The wedge volume in uniplanar‐DTO was significantly smaller than that in TT‐HTO and biplanar‐DTO (P < 0.05). No significant differences in the osteotomy surface and the wedge volume were identified between TT‐HTO and biplanar‐DTO. Conclusion: TT‐HTO can protect the patellar tendon insertion and avoid postoperative patella infera. The osteotomy surface is large and located in an area of cancellous bone, which ensures its good healing characteristics. [ABSTRACT FROM AUTHOR]

Objective: C2 pedicle screw insertion is very important in posterior upper cervical surgery. The traditional screw placement technique requires us to consider both medial inclination and cephalad angle, it is difficult to operate intraoperatively. This paper is to explore a novel method of C2 pedicle screw placement compared with traditional C2 pedicle screw. Methods: A total of 44 patients diagnosed with atlantoaxial fracture or instability from May 2018 to November 2020 were involved in this retrospective study, and they were divided into C2‐PPS group (perpendicular to the coronal plane C2 screw, 24 patients) and C2‐TPS group (traditional C2 pedicle screw, 20 patients). The diameter of the maximum tangential circle, distance between geometric center and median sagittal plane and screw length of PPS and TPS were measured based on the 3D model of C2, respectively. Then the 3D printed navigation templated were designed and manufactured by 3D printing to assisted the PPS and TPS placement, respectively. The surgical time and radiation exposure times during operation were recorded; the post‐operative grading criteria, deviation of screw entry point and deviation of screw angle of two groups were evaluated, respectively. Results: A total of 48 screws were inserted in the C2‐PPS group, and 40 screws were inserted in the C2‐TPS group. There were 46 screws with grade 0 (95.8%) in the PPS group and 31 screws with grade 0 (77.5%) in the TPS group, (P = 0.03). The radiation exposure times in the C2‐PPS group and C2‐TPS group were 4.7 ± 1.5 and 7.8 ± 3.8, respectively, (P = 0.045). The deviations of screw entry point in the C2‐PPS group and C2‐TPS group were 1.2 ± 0.8 mm and 3.2 ± 1.3 mm, respectively; the deviations of screw angle in the C2‐PPS group and C2‐TPS group were 2.1 ± 1.6° and 4.8 ± 2.0°, respectively, (P = 0.000). The diameters of the maximum tangential circle in the C2‐PPS group and C2‐TPS group were 5.5 ± 1.0 mm and 5.3 ± 0.9 mm, respectively. The distances between the geometric center and median sagittal plane in the C2‐PPS group and C2‐TPS group were 15.4 ± 2.3 mm and 18.0 ± 3.3 mm, respectively; The screw lengths in the C2‐PPS group and C2‐TPS group were 25.9 ± 3.2 mm and 27.6 ± 3.7 mm, respectively, (P = 0.000). Conclusion: Eighty percent of C2‐PPS corridor can accommodate a 3.5 mm diameter screw, and with an average screw length of 26 mm. Navigation templates assisted the C2‐PPS placement is less surgical time, less radiation exposure times, more safe and more accurate than C2‐TPS. [ABSTRACT FROM AUTHOR]

For patients with non‐traumatic osteonecrosis of the femoral head (ONFH), core decompression (CD) and bone grafts (BG) are mainly performed in the West, while osteotomy is found to be predominant in Japan. It is not well recognized how the surgical procedures for joint preservation in patients with ONFH are completely different between the United States and Japan. This paper identifies the contexts and the differences in treatment strategies for ONFH between the two countries. We compared the surgical trends of the two countries over three periods, 1997–2001, 2002–2006, and 2007–2011 (the US data for the third period was 2007–2008), based on a 2014 US paper and a 2013 national publication in Japan. We compared the details of surgery for non‐traumatic ONFH under the same conditions in the two reports. For the period 1997–2001, the rates of surgeries for ONFH in the US were as follows: total hip arthroplasty (THA), 86%; CD, 10%; and osteotomy, 0.4%. In Japan, THA was 61%, osteotomy 38%, and CD 0%. For the recent period, 2007–2011 (US 2007–2008), the rate of THA was 91%, CD 6%, and osteotomy 0.1%, in the US, compared to a THA rate of 73%, CD 0%, and osteotomy 26% in Japan. The results for the interim period (2002–2006) were between the old and new data. The use of joint‐preserving surgery for ONFH differs greatly between the US and Japan. The first‐line joint‐preserving surgery was CD in the US and osteotomy in Japan. Each procedure was rarely done in the other country. From about 2000 to 2010, the percentage of THA increased in both countries. The proportion of joint‐preserving surgery (CD in the US and osteotomy in Japan) declined. The decrease in joint‐preserving procedures may be largely attributed to improved long‐term outcomes of THA due to technological advances. There is also a reluctance for young ONFH patients to undergo joint‐preserving procedures, such as osteotomy, that require long‐term hospitalization. [ABSTRACT FROM AUTHOR]

China is a great country, and history teaches us that it was the largest producer and provider of goods and tools, as well as being a nation that developed many concepts and ideas in different fields of activity, including medical science. Many shoulder and elbow schools have Chinese fellows and colleagues who are actively contributing to the scientific development of shoulder and elbow surgery in China. The current special issue of I Orthopaedic Surgery i includes scientific papers from different shoulder, elbow, and orthopaedic departments that specialize in articular surgery and quality modern treatment. Reverse shoulder arthroplasty became very popular in the last 20 years, and currently China is developing this chapter for better patient care, offering new solutions in shoulder reconstruction for orthopaedic and traumatic conditions. [Extracted from the article]

Objective: For pelvic ring fractures, screw fixation became a popular technique for its good biomechanical performance. The safe insertion of anterograde the transpubic screw is important for patients with anterior pelvic ring fractures. This paper is to research the anatomical parameters of the anterograde transpubic screw corridor and evaluate the safety of anterograde transpubic screw placement assisted by the assembled navigation template. Methods: Fifty subjects with normal pelvic, 25 men and 25 women, age from 20 to 60 were enrolled, and their ilium were 3D reconstructed. The ilium was divided into zone I, zone II and zone III. Zone I and zone III was defined as medial and lateral to the obturator foramen, respectively. Zone II is located between zones I and III. The corridor A is formed by zone I and zone II and corridor B is formed by zone I, zone II and zone III. The diameter and length of the inner circle, the distance from the center of the inner circle to the posterior superior and to the inferior iliac spine of corridor A and corridor B were measured, respectively. Nine patients with pelvic fractures underwent anterograde transpubic screw and transverse sacroiliac screw placement assisted by the assembled navigation template and were retrospectively analyzed. Operation time, blood loss, incision length and fluoroscopy times were recorded. Grading score and Matta score were evaluated after surgery. Results: In the 50 subjects, the diameter of corridor A was 11.16 ± 2.13 mm, and that of corridor B was 8.54 ± 1.52 mm. The length of corridor A was 86.39 ± 9.35 mm, and that of corridor B was 117.05 ± 5.91 mm. The surface distance from the screw entry point to the posterior superior iliac spine in corridor A was 109.31 ± 11.06 mm, and that in corridor B was 127.86 ± 8.23 mm. The surface distance from the screw entry point to the posterior inferior iliac spine in corridor A was 91.16 ± 10.34 mm, and that in corridor B was 106.92 ± 7.91 mm. A total of 18 sacroiliac transverse screws and 11 anterograde transpubic screws were inserted assisted by assembled navigation templates for nine patients. The average operation time was 108.75 ± 25.71 min, the blood loss was 141.11 ± 50.21 ml, the incision length was 14 ± 4.62 cm, and the intraoperative fluoroscopy was 17.89 ± 4.01 times. Conclusion: Transpubic screw corridor can be obtained by 3D reconstruction. For the majority of patients, the anterograde pubic ramus corridor accommodated a 6.5 mm diameter screw. It is safe to use anterograde transpubic screw placement assisted by an assembled navigation template. [ABSTRACT FROM AUTHOR]

Background: Charcot joint disease is a rare neurogenic lesion of the joint characterized by progressive joint destruction with dislocation or subluxation. However, whether a joint replacement should be performed for severe joint damage is controversial. Case presentation: This paper reports a case of severe Charcot joint disease with a large bone defect that was treated with arthroplasty assisted by a customized 3D‐printed porous tantalum. The patient was admitted to the hospital with a 9‐year history of bilateral knee pain that had aggravated in the past 2 months. Radiography showed osteogeny and sclerosis in both knees, free bone fragments, heterotopic ossification, new bone, and osteophyte formation, irregular margins, apparent narrowing of joint space, and severe joint damage (Anderson Orthopedic Research Institute classification type III). Based on the present illness, history, imaging, and laboratory examination, Charcot joint disease was confirmed. Conservative treatment has been reported in the literature. There are limited reports on the surgical treatment of severe Charcot joint disease. We followed up with the patient for a year after the operation, and the imaging and clinical evaluation results were good. Postoperative X‐ray examinations showed good alignment of force lines, good joint space, and no evidence of loosening. The patient was mobile and did not need crutches. Conclusions: Through accurate surgical evaluation and preparation of 3D‐printed porous tantalum implants, severe AORI classification type III Charcot joint disease can effectively restore the range of motion of the knee joint, the lower limb alignment, and finally achieve good functional results of walking without crutches. [ABSTRACT FROM AUTHOR]

Malrotation is a cause of persistent pain and poor functioning postoperatively in those who undergo a total knee replacement ( TKR). The accurate measurement of malrotation is not routinely available in most hospital settings due to an absence of three-dimensional computed tomography ( CT) software. An accessible, uncomplicated technique to demonstrate TKR prosthesis malrotation would be of benefit to orthopaedic surgeons worldwide. A patient was reviewed with persistent postoperative pain, having undergone a right TKR 3 years previously for progressive osteoarthritis. Postoperative prosthetic infection, instability, loosening, and fracture were ruled out as causes for the persistent pain. A two-dimensional CT scan was obtained of the patient's affected right knee. Adhesive pieces of paper ( Post-it notes) were used to highlight the posterior tibial prosthesis axis, the tibial tuberosity axis, the posterior condylar axis of the femoral prosthesis and the femoral surgical transepicondylar axis, as per the technique described by Berger et al. A protractor was used to assess the degree of malrotation of the tibial and femoral prostheses. Allowing for human error and that of parallax, an immediate assessment was made of the patient's prosthesis using a readily available imaging modality, and malrotation was quickly identified using accessible, affordable everyday stationary equipment. [ABSTRACT FROM AUTHOR]

Objective: A stable animal model was needed to study bone non‐union caused by insufficient blood supply, the main object of this paper is to develop a medial malleolar fracture model with controllable arterial vascular injuries in rats for revealing the biochemical mechanism of non‐union by insufficient blood supply. Methods: A total of 18 rats were randomly divided into three equal groups: the Sham group, the Fracture group, and the Fracture + Vascular group. The animals were subjected to unilateral medial malleolar bone fracture and vascular injury using customized molding equipment. The fracture site was scanned by micro‐CT, and vascular injury was evaluated by laser Doppler flowmetry (LDF) 24 h after modeling. Histological examination (HE), alkaline phosphatase (ALP) and tartrate‐resistant acid phosphatase (TRAP) staining, immunohistochemistry and immunofluorescence were conducted on the medial malleolar fracture tissues of three rats randomly selected from each group 24 h after modeling. Subsequently, to further confirm the success of fracture modeling, the fracture sites of three other rats in each group underwent micro‐CT scanning again 6 weeks after surgery. Results: The results of a 24 h micro‐CT showed that all rats used to create the fracture models showed controlled injury of the medial malleolus. The model was stable, and the satisfaction of the homemade equipment agreed with the expectation. LDF showed that the blood flow of rats in the Fracture + Vascular group decreased significantly 24 h after fracture injury, while collateral blood flow perfusion increased by 50% on average. The results of HE, ALP and TRAP staining in the medial malleolus showed that the number of osteoblasts (OBs) and osteoclasts (OCs) in the Fracture group increased significantly, but the number of OBs and OCs in the Fracture + Vascular group decreased sharply relative to the number in the Sham group 24 h later. Furthermore, immunohistochemistry and immunofluorescence results showed that the number of neovessels in the Fracture group was significantly increased, while the number of neovessels in the Fracture + Vascular group was significantly decreased, which was consistent with the above results. After 6 weeks of modeling, the micro‐CT results showed that the fractures in the Fracture group had healed substantially, while those in the Fracture + Vascular group had not. Conclusion: This study provided a reproducible and stable experimental animal model for medial malleolar fractures with arterial injury. [ABSTRACT FROM AUTHOR]

Postoperative infections following implant‐related spinal surgery are severe and disastrous complications for both orthopaedic surgeons and patients worldwide. They can cause neurological damage, disability, and death. To better understand the mechanism of these destructive complications and intervene in the process, further research is needed. Therefore, there is an urgent need for efficient, accurate, and easily available animal models to study the pathogenesis of spinal infections and develop new and effective anti‐bacterial methods. In this paper, we provide a general review of the commonly used animal models of postoperative implant‐related spinal infections, describe their advantages and disadvantages, and highlight the significance of correctly choosing the model according to the infection aspect under investigation. These models are valuable tools contributing to the better understanding of postoperative spinal infections and will continue to facilitate the invention of novel preventative and treatment strategies for patients with postoperative spinal infections. However, although they are valid and reproducible in some respects, the current animal models present certain limitations. Future ideal spinal infection animal models may assess the bacterial load of the same animal in real‐time in vivo, and better mimic the human anatomy as well as surgical techniques. Strains other than Staphylococcus aureus account for a large proportion of postoperative spinal infections, and thus, the establishment of models to evaluate other types of microbial infections is expected in the future. Furthermore, novel transgenic models established on advancements in genome editing are also likely to be developed in the future. [ABSTRACT FROM AUTHOR]

Objective: To highlight the characteristics of the most highly cited articles and propose the research interests over the past decades in the field of femoroacetabular impingement (FAI) and labral tear. Methods: The ISI Web of Science database (Clarivate Analytics, New York, the United States) was utilized for the identification of articles on 15 December 2020. FAI and labral tear‐related articles (1138 articles) were retrieved, of which the 100 most‐cited articles (top 100) were identified. Subsequent analysis included citation density (citations/article age), authorship, institution, journal, geographic distribution, level of evidence, and theme. Results: The number of citations per article ranged from 66 to 1189 with a mean of 163.31. The majority of articles were published in the United States (all articles/top 100 = 655/57) and Switzerland (85/22). University of Bern (n = 10) was the most prolific institution. The journal with the most of articles was Arthroscopy: The Journal of Arthroscopic and Related Surgery. The most prolific coauthor (all articles) or first authors (top 100) was Domb (n = 109) and Philippon (n = 6), respectively. The evidence with the most articles is level IV (n = 41). The top three most popular topics of research article were outcomes of surgery (n = 23), imaging diagnosis (n = 18), and comparison of surgery (n = 8). The top four most prevalent themes of review were labral tears (n = 3), FAI (n = 3), comparison of surgery imaging diagnosis, and outcomes of surgery (both n = 2). Six keywords with the newest average publication year, including FAI syndrome (average publication year = 2019.50), patient‐reported outcomes (2019.43), femoroplasty (2018.60), clinical outcomes (2018.17), borderline dysplasia (2018.00), and capsule (2018.00). Five keywords with the highest average citations, including outcome (average citations = 88.50), alpha angle (58.00), complications (55.86), revision hip arthroscopy (49.00), and systematic review (46.14). Conclusions: Outcomes research is the most popular research interest and patient‐reported outcome instruments might be further and widely used in the emerging articles in the near future. The field of FAI and labral tear has shown an obvious trend of development and is steadily evolving. It could be predicted that there will be an increasing number of publications in the following years, with the United States and Switzerland maintaining leadership in this field. [ABSTRACT FROM AUTHOR]

Osteoarthritis causes joint pain and functional disorder, of which knee osteoarthritis is the most common. Nowadays, clinically effective treatments mainly include conservative treatment, arthroplasty, and osteotomy. However, conservative treatment only offers symptomatic relief and arthroplasty is limited to the patients with a moderate to severe degree of osteoarthritis. For relatively young patients who require greater knee preservation, a surgical treatment with low operation trauma and revision rate is needed. Osteotomy around the knee, based on the notion of "knee preservation," has been chosen as an alternative surgical treatment. Cutting and realigning the bones corrects the mechanical line of lower limb force bearing. As such, osteotomy around the knee retains normal anatomical structure and obtains good functional recovery of the knee joint. The techniques of osteotomy around the knee includes anti‐varus deformity and anti‐valgus deformity osteotomy, aiming to reallocate the force bearing in the compartment of the knee joint. By choosing the surgical section of the lower limbs, the osteotomy around the knee can achieve the correction of mechanical axis, such as the high tibial osteotomy (HTO), proximal fibular osteotomy (PFO), and distal femur osteotomy (DFO). Numerous modified techniques have been developed to meet the demands of patients based on traditional methods. These modified osteotomy have their own advantages and indications. This paper aims to guide clinical treatment by reviewing different types of osteotomies, and their effects, that have been studied and applied widely in clinical practices. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present paper was to investigate the clinical efficacy of minimally invasive elastic stable intramedullary nailing (ESIN) for long bone fractures in children. Methods: A total of 350 children with limb fractures from June 2012 to June 2018 were recruited and randomized into two groups: an ESIN group (n = 175) treated with elastic stable intramedullary nailing, and an MPIF group (n = 175), treated with metal plate internal fixation. Both groups received the same physical examination and routine medication. Operation related indexes, clinical efficacy, complications, and postoperative quality of life scores were analyzed and compared. Results: The operation time, intraoperative blood loss, hospitalization time, and fracture healing time in the ESIN group were 43.74 ± 4.96 min, 8.14 ± 1.34 mL, 5.97 ± 1.88 days, and 55.89 ± 5.61 days, respectively, which were all significantly less than those in the MPIF group (all P < 0.001). In terms of common complications after limb fracture treatment, there were 6 cases of osteomyelitis, 5 cases of skin irritation response, and 7 cases of inflammatory granuloma in the MPIF group. There were 2 cases of skin irritation response and 5 cases of inflammatory granuloma in the ESIN group. The incidence of postoperative complications in the ESIN group was 4.00%, which was significantly lower than that in MPIF group (10.29%) (P < 0.05). The effective rate for recovery condition in the ESIN group (93.71%) was significantly higher than that in the MPIF group (P < 0.001). The quality of life scores after treatment in both groups were improved, while the score in the ESIN group was significantly higher than that in the MPIF group (79.43%) (P < 0.001). The postoperative satisfaction rate in the ESIN group (94.29%) was significantly higher than that in the MPIF group (86.29%) (P < 0.05). The quality of life scores after treatment in both groups were improved, while the score in the ESIN group was significantly higher than that in the MPIF group (P < 0.001). The postoperative satisfaction rate and the acceptance rate for adjacent joint function in the ESIN group (100%) were significantly higher than those in the MPIF group (92.00%) (P < 0.0001). Conclusion: Elastic stable intramedullary nailing is a minimally invasive procedure for long bone fractures in children. It can effectively improve the operation‐related indicators and postoperative quality of life and reduce the incidence of complications. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present paper was to evaluate the safety and clinical efficacy of mini‐open retroperitoneal oblique lumbar interbody fusion (OLIF) for the treatment of lumbar spinal tuberculosis. Methods: A total of 115 patients who suffered from lumbar spinal tuberculosis from June 2014 to December 2017 were included in this research. A total of 59 patients underwent OLIF and percutaneous pedicle screw fixation (OLIF group) and 56 patients underwent the anterior‐only approach (anterior‐only group). All patients were followed up for at least 24 months. Operation time, blood loss, and rate of complications were used to assess the safety of these two techniques. The visual analog scale (VAS) and the Oswestry disability index (ODI) were used to evaluate the relief of neurological and functional symptoms. The erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP) were measured to investigate the activity and recurrence of spinal tuberculosis. The Cobb angle, the sagittal vertical axis of the spine (SVA), the pelvic tilt (PT), the sacral slope (SS), the pelvic incidence (PI), and postoperative Frankel classification were also used to assess the efficiency of the spine deformity correction and the recovery of long‐term neurological function. Results: Most patients were successfully treated with OLIF and the anterior‐only technique and attained satisfactory clinical efficiency during the 24‐month follow‐up period. In the perioperative period, the mean operative time (154.68 ± 23.64 min, P < 0.001), the mean blood loss (110.57 ± 87.67 mL, P < 0.001), and the mean hospital stay (9.55 ± 3.62 days, P < 0.001) of the OLIF group were all significantly lower than in the anterior‐only group (172.49 ± 25.67 min, 458.56 ± 114.89 mL, and 14.89 ± 3.89 days, respectively). A total of 10 patients (16.95%) experienced complications in the OLIF group, including neurological injury, segmental artery and iliac vein lacerations, peritoneal injury, instrument failure, and infection of incisions; this rate of complications was lower than in the anterior‐only group (37.50%, P = 0.013). Regard to spinal deformity correction, the Cobb angle (9.42° ± 1.72°, P = 0.032), the SVA (2.23 ± 1.07 cm, P = 0.041), the PT (14.26° ± 2.37°, P = 0.037), and the SS (39.49° ± 2.17°, P = 0.042) of the OLIF group at last follow‐up were all significantly different when compared to the anterior‐only group (14.75° ± 2.13°, 3.48 ± 0.76 cm, 18.58° ± 1.45°, and 36.78° ± 1.96°, respectively). The VAS and the ODI of the OLIF group at 1 week postoperatively (3.15 ± 0.48, 21.85 ± 3.78, P = 0.032, 0.037) and at the last follow‐up (2.12 ± 0.35, 16.70 ± 5.25, P = 0.043, 0.035) were both lower than for the anterior‐only group (5.18 ± 0.56, 29.83 ± 5.42 and 3.67 ± 0.62, 20.68 ± 6.23). The Frankel classification was improved for both OLIF and anterior‐only patients; however, there were 35 cases (59.32%) classified as Frankel grade E in the OLIF group and 22 cases (39.29%, P = 0.021) in the anterior‐only group Conclusion: The OLIF surgical technique for single lumbar (L2–L5) spinal tuberculosis is less invasive, has lower complication rates, and is more efficient than the anterior‐only approach. However, the long‐term effects of this surgical technique still need to be explored. [ABSTRACT FROM AUTHOR]

Background: Wear debris pseudotumors are a rare complication after total knee arthroplasty (TKA) and have seldom been reported in the recent literature. There is no consensus on the best therapeutic method, but the high quality curative treatment, safe, low invasive treatments are required for the patients. Case presentation: In this paper, we present the case of a 74‐year‐old man with a wear debris pseudotumor after TKA with symptoms of severe pain and functional disability of his right knee. X‐ray examination showed that the medial compartment of the right knee was narrowing. Magnetic resonance imaging (MRI) and Doppler ultrasound both revealed a polycystic mass at the posteromedial side of the patient's right knee. Considering the bad health condition and the minimally invasive surgery requirement of this senior patient, arthroscopic knee debridement and percutaneous cystic mass suction were carried out simultaneously. Video arthroscopy of the right knee showed visible inflammatory soft tissue, obvious polyethylene fragments, wear of the polyethylene prothesis, and a broken polyethylene insert. The intraarticular polyethylene wear debris was removed as much as possible, and inflammatory soft tissue was debrided and sent for pathology. Postoperative pathology showed polyethylene debris in the soft tissue with an apparent multinucleated giant cell response, which was consistent with foreign body granuloma. All clinical manifestation was improved and Lysholm scores were significantly better at one year with this treatment, increasing from 32 points to 71 points. Conclusion: After two years of follow‐up, the patient's knee joint was significantly relieved from soreness and pain, and walking was not significantly restricted. Our treatment could not address the root cause of the wear debris pseudotumor, which was due to prosthesis failure, but sometimes, such an approach is the safest, most economical, and most effective choice for patients who are intolerant to reoperation. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present paper was to explore the clinical effect of one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation for thoracolumbar osteoporosis vertebral compression fractures (OVCF). Methods: This is a single‐center retrospective analysis. A total of six thoracolumbar OVCF patients (four women and two men) with an average age of 65.2 years (58–72 years) who were treated between June 2016 and May 2018 were enrolled in the present study. The lesion segments included: 1 case at T11, 1 case at T12, 3 cases at L1, and 1 case at L2. The six thoracolumbar OVCF patients were treated with one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation. After general anesthesia, patients were placed in the right lateral decubitus position, an approximately 10–15‐cm oblique incision was made along corresponding ribs, and the conventional left retroperitoneal and/or the extrapleural approach was performed for anterior lateral exposure. First, anterior decompression and fixation were performed, and then through the unilateral paraspinal muscle approach, posterior pedicle screw fixation was performed under the same incision. The back pain visual analogue scale (VAS), the Oswestry disability index (ODI), and the MacNab criteria were used to evaluate the clinical outcome. The radiographic analysis included the regional kyphosis angle and the fusion rate. Neurological status, operation time, intraoperative bleeding, the time of ambulation, hospital stay, and surgical complications were also assessed. Results: Surgery was successful in all six patients, who were followed up for 31.6 months (range, 23–46 months). The operation time was 125–163 min, with a median of 135 min. The preoperative blood loss was 580–1230 mL, with a median of 760 mL. The time of ambulation was 3–5 days, with a median of 4.2 days. The hospital stay was 8–15 days, with the median of 10.5 days. According to the Frankel classification of neurological deficits, of two patients with grade C preoperatively, one had improved to grade D and one had improved to grade E at final follow up; among four patients with grade D preoperatively, at the final follow up one remained the same and three had improved to grade E. The postoperative back pain VAS score decreased significantly, from 6.17 ± 0.75 preoperatively to 0.83 ± 0.41 postoperatively (P < 0.05). The mean ODI score was 73.7 ± 5.86 preoperatively and reduced to 21.85 ± 3.27 postoperatively (P < 0.05). According to the MacNab criteria, at the final follow up, two patients rated their satisfaction as excellent, three patients as good, and one patient as fair. The mean regional kyphosis angle was 22.17° ± 6.01°before surgery, which improved to 9.33° ± 3.88° at the final follow up (P < 0.05). At the final follow up, there were two patients who had achieved a grade 2 bony fusion (33.3%), three patients grade 3 (50.0%), and one patient grade 4 (16.7%). No incision infections, internal fixation failures or other complications were found during the perioperative and the follow‐up period. Conclusion: One approach anterior decompression and fixation with posterior unilateral pedicle screw fixation provides a novel method for thoracolumbar OVCF disease, with a satisfactory clinical outcome. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present paper was to evaluate the strength and the magnitude of the association between ossification of the nuchal ligament (ONL) and the risk of cervical ossification of the posterior longitudinal ligament (COPLL) and to determine whether there is a direct association or whether COPLL is a consequence of shared risk factors. Methods: Medline, Web of Science, Cochrane Library, and Embase databases were searched for studies evaluating the association of COPLL‐ONL published before July 2020. Eligible studies were selected based on certain inclusion and exclusion criteria. Two investigators independently conducted the quality assessment and extracted the data, including study designs, countries, patients' age, gender, body mass index (BMI), and the risk of COPLL between individuals with and without ONL. A meta‐analysis of homogenous data, a sensitivity analysis, a publication bias assessment, and a subgroup analysis were performed using Stata 12.0 software. Results: A total of 10 cohort studies involving 8429 participants were incorporated into this analysis. Pooled results demonstrated a statistically significant association between the presence of ONL and the increased COPLL risk (odds ratio [OR] 3.84; 95% confidence interval [CI] 2.68–5.52, P < 0.001). Furthermore, subgroup analyses indicated that this association was independent of study design (6.36‐fold in case‐control studies vs 3.22‐fold in cross‐sectional studies), sex (6.33‐fold in male–female ratio >2.5 vs 2.91‐fold in male–female ratio <2.5), age (4.28‐fold in age ≥55 years vs 3.45‐fold in age <55 years), and BMI (3.88‐fold in BMI ≥ 25 kg/m2vs 2.43‐fold in BMI < 25 kg/m2), which also indicated that obese, older male patients with ONL had a higher risk of OPLL. Moreover, combined two articles revealed that patients with larger‐type ONL had a significantly higher risk of long‐segment COPLL compared with controls (OR 1.86; 95% CI 1.41–2.47, P < 0.001). Conclusion: This is the first meta‐analysis to demonstrate a strong and steady association between ONL and higher risk of COPLL. This association was independent of sex, age, and BMI. Considering that ONL is generally asymptomatic and easily detectable on X‐ray, our findings implied that ONL might serve as an early warning sign of the onset of COPLL and provide clinicians an opportunity for early detection and early intervention. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present paper was to investigate the value of obturator oblique and pubic ramus inlet views in guiding anterior column acetabular screw insertion. Methods: We collected pelvic CT scans at the diagnostic imaging center of our hospital between 2017 and 2019. Virtual three‐dimensional (3D) models of the pelvis were created based on the CT scans. Then the transparency was adjusted to 30%. Two identical copies of the 3D model data were made. 3D model replications were divided into a control group and an experimental group. In the control group, the screw was inserted into the anterior acetabular column using obturator‐outlet and iliac‐inlet views. In the experimental group, the screw was guided under obturator oblique and pubic ramus inlet views. Based on whether the screw penetrated the hip joint and/or exited the pubic ramus, models were divided into three grades. Grade I: the screw travels completely within the anterior column bone corridor; Grade II: the screw exits the superior pubic ramus, but the length of the screw outside the channel does not exceed 1/2 of the anterior column; Grade III: the screw exits the superior pubic ramus and the length of the screw outside the corridor exceeds 1/2 of the anterior column. We compared the screw placement quality of the two groups and analyzed differences between genders. In addition, the distance between the screws and the acetabulum was recorded and compared among the two groups. Results: A total of 110 hemipelves were selected, including those of 80 men and 30 women, with an average age of 46.76 ± 14.26 years. In the control group, the screw quality of 64 models (58.2%) was Grade I. In the experimental group, 94 models (85.5%) had Grade I screw placement quality. Grade II screw placement quality accounted for 18.2% of the control group and 7.3% of the experimental group. In the control and the experimental groups, there were 26 and 8 cases with Grade III screw placement quality, respectively. The quality of screw placement in the experimental group was significantly better than that in control group, and the difference between the two groups was statistically significant (P < 0.01). The distance between the screw and the acetabulum in the control group and experimental group was 0.92 ± 0.49 mm and 2.78 ± 1.15 mm, respectively. The difference between the two groups was statistically significant. Conclusion: Anterior column acetabular screws can be inserted successfully and more accurately using the obturator oblique and pubic ramus inlet views. [ABSTRACT FROM AUTHOR]

Objective: To analyze perioperative complications, resource consumption, and inpatient mortality of patients who receive total joint arthroplasty (TJA) with a concomitant diagnosis of a primary hypercoagulable state (PHS). The following questions were posed in the present paper. First, do patients undergoing TJA with PHS have increased risk of deep venous thrombosis (DVT), pulmonary embolism (PE), and periprosthetic joint infection (PJI)? Second, what other in‐hospital complications are more likely among PHS patients undergoing TJA? Third, do TJA patients with PHS usually consume greater in‐hospital resources? Fourth, do PHS patients suffer higher mortality rates compared to non‐PHS patients? Finally, have PHS patients received proper anticoagulant management in past arthroplasties? Methods: The National Inpatient Sample (NIS) database for the years between 2003 and 2014 was searched to identify patients undergoing primary TJA. Patients with PHS were identified with the ICD‐9‐CM code 289.81. The χ2‐test, the Pearson test, and adjusted multivariate regression analysis were performed to evaluate the difference and odds ratios between the positive and negative diagnosis groups. Results: From 2003 to 2014, a total of 2,044,356 patients were identified in the NIS as undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) in the United States. A total of 4664 patients (0.2%) were identified as having PHS. Compared with the non‐PHS group, TJA patients with PHS had a higher risk of DVT (THA: odds ratio [OR] = 8.343, 95% CI: 5.362–12.982, P < 0.001; TKA: OR = 4.712, 95% CI: 3.560–6.238, P < 0.001) but did not have increased risk of PE (THA: OR = 1.306, 95% CI: 0.48–3.555, P = 0.602; TKA: OR = 1.143, 95% CI: 0.687–1.903), and only PHS patients in the THA group had higher risks of inpatient mortality (OR = 3.184, 95% CI: 1.348–7.522, P = 0.008) and periprosthetic joint infection (OR = 3.343, 95% CI: 1.084–10.879, P = 0.036). In addition, PHS patients had extended length of stay, higher total costs, and increased risks of certain other complications, such as peripheral vascular disease, hemorrhage, and thrombophlebitis. Conclusion: In the present study, PHS patients had higher risks of DVT, greater in‐hospital resource consumption, and certain other perioperative complications. However, PHS was not associated with increased risk of PE in TJA patients in the United States between 2003 and 2014. While potential hazards of PHS have already been recognized, the present study revealed additional concerns and demonstrated that further improvements in the perioperative management of patients with hereditary hypercoagulable disorders are essential. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present paper was to evaluate cases of lumbar degenerative diseases treated with oblique lateral interbody fusion (OLIF) using a modified lateral approach (i.e. anteroinferior psoas exposure under direct vision) and to analyze the effect and safety of this approach. Methods: From June 2016 to April 2019, a total of 226 patients with an average age of 65.5 ± 16.2 years (98 men and 128 women) with degenerative lumbar diseases who underwent the AIP approach of OLIF were followed up and analyzed retrospectively. Data concerning operative and clinical parameters were collected, including operative time, intraoperative estimated blood loss, duration of postoperative hospital stay, and time to ambulation after surgery. For the assessment of clinical outcomes, the visual analogue scale (VAS) score (for back pain) and the Oswestry disability index (ODI) were calculated. Complications were also recorded as surgical exposure approach‐related complications. More than 6 months after surgery, 132 patients consented to having MRI examinations to evaluate the psoas muscle atrophy when they were followed up. Results: The mean operative time was 82.5 ± 31.6 min. The mean operative time for each segment of OLIF was 43.3 ± 15.5 min. The mean blood loss was 48.0 ± 11.6 mL. The mean blood loss for each segment of OLIF was 25.3 ± 10.1 mL. No patients needed blood transfusion intraoperatively or postoperatively. The mean hospital stay was 4.1 ± 2.1 days. All patients were followed up for 12–31 months (mean 18.2 months). Clinical assessment showed that the VAS and ODI scores at 6 months after surgery were markedly lower than the preoperative scores (P < 0.001) but did not differ from the scores at the final follow‐up (P > 0.05). There was no significant difference in percentage changes of the cross‐sectional area of the lean psoas muscle and the T2 signal intensity ratio of gross psoas to quadratus lumborum muscles between the left side (operative side) and the right side (nonoperative side) (P > 0.05). A total of 11 surgical exposure approach‐related complications were reported, with an incidence of 4.9%: transient thigh pain/numbness, psoas weakness (2.2%), sympathetic chain injury (1.3%), cage subsidence (0.9%), and segmental artery injury (0.4%). There was no permanent motor neurological deficit, and no injury of vascular, ureter or peritoneal membranes. Conclusion: The anteroinferior psoas approach for OLIF is safe and can preserve the psoas and lumbar plexus. [ABSTRACT FROM AUTHOR]

The aim of the present paper was to identify, appraise, and synthesize the available evidence on two‐stage revision hip arthroplasty with or without the use of an interim spacer for managing late prosthetic infection. The review methodology was designed by referencing the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) checklist and flow diagram, and a Population, Intervention, Comparator, Outcomes and Study (PICOS) design framework was used to search for studies to incorporate within the review. Two independent investigators were involved in searching for relevant articles that fulfilled the inclusion criteria for the study. Critical appraisal of the selected articles was carried out using the relevant Critical Appraisal Skills Programme checklists. From an initial pool of 125 articles, four studies satisfied the inclusion criteria and quality assessment and were included for final review. Two patient groups were identified from within the selected studies: spacer and non‐spacer. Both groups were assessed in terms of functional outcome, infection cure rates, and technical difficulties encountered during treatment. Better functional outcome was reported in the spacer group, both in the interim period between the two stages and after completion of treatment. The use of spacers reduced operative difficulty during the second stage and accelerated patient discharge. Reinfection and infection persistence rates were higher in the non‐spacer group. Within the spacer group, articulated spacers performed better in all parameters. The results of this review reinforce the available evidence supporting the use of interim hip spacers in revision hip arthroplasty for managing prosthetic infection and also indicate that articulated hip spacers could be an attractive option going forward. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present paper was to reveal the clinical differences between selective and nonselective decompression for symptomatic tandem stenosis of the cervical and thoracic spine (TSCTS). Methods: A total of 34 patients were eligible and included in the study. Among them, 8 patients underwent selective cervical decompression (CD), 15 patients underwent selective thoracic decompression (TD), and 11 patients underwent combined CD and TD (CTD) surgery. Age, sex, operative time, intraoperative blood loss, postoperative hospital stay, inpatient expenditure, preoperative upper Japanese Orthopaedic Association (JOA) rate, canal occupation rate, high‐intensity T2‐weighted image (T2WI) of the spinal cord, and preoperative and postoperative JOA scores were compared among the three groups. Results: The CD group had shorter operative time (138.8 ± 36.1 vs 229.7 ± 95.8 vs 328.6 ± 94.8, min, P < 0.001), less intraoperative blood loss (141.3 ± 116.7 vs 496.7 ± 361.8 vs 654.6 ± 320.5, mL, P = 0.004), and shorter postoperative hospital stay (4.6 ± 1.6 vs 9.0 ± 3.5 vs 10.3 ± 6.6, days, P = 0.008), as well as lower preoperative upper JOA rate (34.1 ± 5.6 vs 53.9 ± 8.4 vs 48.2 ± 15.2, %, P = 0.001) than the TD and CTD groups. The CTD group had higher inpatient expenditure than the CD and TD groups (87,850 ± 18,379 vs 55,100 ± 12,890 vs 55,772 ± 15,715, CNY, P < 0.001). The cervical canal occupation rates were similar among different groups (P > 0.05); however, the TD group showed a higher thoracic canal occupation rate than the CD group (58.3 ± 14.7 vs 43.3 ± 12.3, %, P = 0.035). All positive levels in high‐intensity T2WI of the spinal cord were decompressed. The preoperative JOA scores as well as the postoperative JOA scores at 6 months and at last follow‐up were comparable among the three groups (P > 0.05). Similarly, the JOA recovery rate showed no significant difference among the groups (P > 0.05). Conclusion: Selective CD or TD alone demonstrated similar clinical effectiveness to nonselective and combined CTD for TSCTS. Individualized surgical decision should be made after meticulous assessments of clinical and radiological manifestations, general patient condition, and socioeconomic factors. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper is to investigate the effects of senescent nucleus pulposus cell (NPC)‐derived exosomes (SNPC‐Exo) and the roles of the P53/P21 pathway on the senescence of NPC. Methods: The senescent phenotypes of NPC were induced by interleukin‐1β treatment. SNPC‐Exo was extracted from the culture medium of senescent NPC and purified by differential centrifugation. The structure of SNPC‐Exo was identified by transmission electron microscopy and western blot analysis was used to determine the exosomal marker proteins CD63 and Tsg101. Western blot analysis was performed to determine the relative expression levels of P16, P21, and P53 in NPC. Senescence‐associated β‐galactosidase (SA‐β‐gal) staining was used to stain the senescent NPC and a phase contrast microscope was used to observe and count the SA‐β‐gal staining of NPC. The proliferation of SNPC‐Exo‐treated NPC was assessed using growth curve analysis and the colony formation assay. The cell cycle of SNPC‐Exo‐treated NPC was determined by flow cytometry. NPC were transfected with siRNA to knock down P53 and P21 expression. Results: Interleukin‐1β‐treated NPC had a higher percentage of SA‐β‐gal positive cells (45%) than the control group (20%) and showed an increase in the relative expression of P16, P21, and P53 (P < 0.05). SNPC‐Exo were positive for exosomal marker protein CD63 and Tsg 101 and negative for calnexin, and successfully internalized as previously described. SNPC‐Exo‐treated NPC showed an increase in the relative expression of P21 and P53 (P < 0.05). Compared with the control group, the SNPC‐Exo‐treated NPC showed a lower growth rate (3 times lower on the 5th day and 2 times lower on the 7th day), fewer colony‐forming units (12.0%), and a higher percentage of SA‐β‐gal‐positive NPC (50.0%). The SNPC‐Exo‐treated NPC contained more G1 phase cells (68.0%) and fewer S phase (15.5%) cells than the control group (53.0% in G1 phase, 33.5% in S phase). The expression of P21 and P53 significantly decreased in SNPC‐exo‐treated NPC after siRNA transfection (P < 0.05), followed by a higher growth rate (2 times higher on the 5th day and 1.5 times higher on the 7th day) and lower percentage of SA‐β‐gal‐positive NPC (22.5%). Moreover, the inhibition of the P53/P21 pathway promoted the SNPC‐Exo‐treated NPC to enter the S phase (from 15.5% to 25.3%). Conclusion: The inhibition of the P53/P21 pathway attenuated the senescence of NPC induced by SNPC‐Exo. [ABSTRACT FROM AUTHOR]

To aim of the present paper was to introduce a novel fixation technique for the treatment of inferior pole fracture of the patella. We performed a prospective observational study of consecutive cases of inferior pole fracture of the patella that were treated at our institution between January 2018 and June 2019. The patients include three men and one woman, with an average age of 47 years (range: 42–59 years). All patients were treated with the novel rim plating fixation technique for preserving the inferior pole of the patella. During the surgery, a 2.4 mm straight locking compression plate was contoured to adapt to the arc of the lower half of the patella as the rim plate. After reduction of the fracture, the rim plate was fixed to the proximal fragment of the patella through multiple locking screws, against the continuous pull of the patellar tendon. The rim plate encircles and constricts the inferior pole fragments, functioning as a compression and blocking construct. If necessary, an additional anterior tension band or mini locking plate can be used to further prevent anterior displacement of the inferior pole fragments. Under this rigid fixation, motion of the knee and full weight‐bearing were encouraged postoperatively. The patients were followed up monthly until 12 months after surgery. The time to achieve 90°pain‐free, full range of motion of the knee, and fracture healing, were recorded. Related complications were monitored, including infection, loss of reduction, fixation failure, anterior knee pain, and soft‐tissue irritation. The modified Cincinnati knee rating system was used for knee function assessment. The average operative time was 58.8 min (range: 52–63 min). The average blood loss was 59.8 mL (range: 45–71 mL). For all patients, pain‐free 90° range of motion was restored in 2–4 weeks, and the full range of motion was restored in 8–11 weeks. All patients achieved bone union in 6–9 weeks with no displacement of the fragments or breakage of the implant. No patient complained of anterior knee pain or soft‐tissue irritation. The modified Cincinnati score at 12‐month follow up demonstrated excellent outcomes in all four patients. The rim plating technique may be a feasible option for the treatment of the inferior pole fracture of the patella. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the present paper was to study isolated meniscal ramp lesions without obvious ACL rupture. Their biomechanical mechanisms were analyzed and their clinical characteristics were reviewed. The clinical effects of an all‐inside horizontal mattress suture for isolated ramp lesions were evaluated. Materials and Methods: Twenty isolated meniscal ramp lesion patients without obvious ACL rupture from 2015 to 2017 were retrospectively reviewed. Preoperative MRI showed intact ACL and signs of ramp lesions. These isolated ramp lesions were arthroscopically confirmed and repaired through an all‐inside horizontal mattress suturing method. MRI was performed 3 months postoperatively to assess isolated ramp lesion healing. The Tegner–Lysholm score and the visual analog scale score were recorded preoperatively and at 2 years postoperatively. The Wilcoxon rank sum test was performed to determine statistical significance. Results: Arthroscopic exploration confirmed isolated ramp lesions and longitudinal ACL splits or degeneration without obvious ACL rupture. MRI 3 months postoperatively showed healing of the isolated ramp lesions. At 2 years postoperatively, the VAS scores were significantly decreased and the Tegner–Lysholm scores were significantly increased. Knee function, without pain, was restored in all patients, including walking, climing and descending stairs, and squatting. Conclusion: Isolated meniscal ramp lesions without obvious ACL rupture may exist because of ACL longitudinal splits or degeneration and can be repaired through anterolateral and anteromedial portals with an all‐inside horizontal‐mattress suturing method. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present paper is to analyze mid‐term and long‐term alterations of human anterior cruciate ligament (ACL) grafts during the remodeling process with special regards to cellularity, α‐smooth muscle protein (αSMP) expression, and crimp length in comparison to the native ACL. Methods: A total of 34 patients were included (23 male and 11 female). Biopsies of 13 semitendinosus tendon and 14 patellar tendon autografts were obtained during surgical revision secondary to an ACL reconstruction. According to the interval between the index procedure and sample collection, the patients were divided into four groups: 4–12 months, 13–60 months, 61–108 months, and >108 months. Seven samples of native ruptured ACL tissue obtained during surgical intervention served as control. All biopsies were taken from the intraligamentous part of the ACL or the graft. Histomorphological and immunohistochemical analyses were conducted after samples were stained using hematoxylin–eosin, Giemsa, and αSMP enzyme‐labeled antibodies. The total cell density, the numbers of fibroblasts and fibrocytes, the fibroblast/fibrocyte ratio, the number of αSMP+ cell nuclei, and the percentage of αSMP+ cells per fibroblast as well as the crimp lengths were determined using light microscopy. Results: In the early phase of remodeling, the grafts featured extensively high total cell counts (1021.2 ± 327.8, P = 0.001), with high numbers of fibroblasts (841.4 ± 245.2, P = 0.002), fibrocytes (174.5 ± 113.0, P = 0.04), and αSMP+ cells (78.3 ± 95.0, P = 0.02) compared to controls (390.1 ± 141.7, 304.5 ± 160.8, 65.6 ± 31.4 and 2.3 ± 2.6, respectively). Thereafter, the numbers of all cell entities decreased. After more than 108 months, the percentage of αSMP+ cells per fibroblast reached physiological values (ratio 1.3 ± 1.0, P = 0.41; control 0.8 ± 0.8), while the total cell count (834.3 ± 183.7, P = 0.001) as well as the numbers of fibroblasts (663.5 ± 192.6, P = 0.006) and fibrocytes (134.1 ± 73.0, P = 0.049) remained significantly high. The fibroblast/fibrocyte ratio showed no significant alterations over the course of time compared to the controls. The collagen crimp lengths were elongated by tendency in the early phase (28.8 ± 12.9 mm, P = 0.15; control 20.7 ± 2.2 mm) and significantly shortened over time, with the lowest values in the long term (14.8 ± 2.0 mm, P = 0.001). The comparison of biopsies from semitendinosus tendon and patellar tendon autografts revealed no significant differences for any of the histomorphological parameters investigated. Conclusion: This study reveals distinctive mid‐term and long‐term immunomorphological alterations during human ACL graft remodeling. These data clearly indicate that the remodeling is a process that continues for 9 years or more. Furthermore, it seems to be a process of adaptation rather than full restoration. Even in the long run, several biological properties of the native ACL are not completely reestablished. [ABSTRACT FROM AUTHOR]

Background: Pedicle screw insertion has been known to have several complications even in the most skilled surgical hands. However, injury to the thoracic aorta during pedicle screw insertion is rare, delayed presentation secondary to pseudoaneurysm is even rarer, the pseudoaneurysm formation caused by a series of malpositioned pedicle screws has perhaps not been reported so far. Case presentation: In this paper, we report here a case in which inadvertent injury to the thoracic aorta resulted in pseudoaneurysm, its manifestation was initially vague, resulting in a delayed diagnosis. Delayed aortic pseudoaneurysm or injury can be asymptomatic for a long time. Patients with renewed or continued back pain should alert orthopaedic surgeons regarding the possibility of pseudoaneurysms, regardless of the period that has elapsed after pedicle screw implantation. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present paper was to evaluate the results of one‐stage total hip arthroplasty (THA) for patients with bilateral Crowe type IV developmental dysplasia of the hip (DDH). Methods: Data for 58 patients (116 hips) with bilateral Crowe type IV DDH who had one‐stage THA performed by the same surgeon during the period of April 2008 to February 2019 were retrospectively reviewed. The mean age of the patients was 37.3 years; 5 were men and 53 were women. All patients underwent THA through the posterolateral approach using the Pinnacle acetabular cup, a ceramic‐on‐ceramic bearing, and the modular S‐ROM stem. Subtrochanteric shortening osteotomy was performed on 86/116 hips. Intraoperative conditions were recorded. Radiographic and functional outcomes were evaluated, and complications were recorded. Results: All patients were followed up for an average of 71.3 ± 37.6 months (range, 12–140). The mean operative time was 276.5 ± 57.9 min (range, 175–540). The mean intraoperative blood loss was 933.6 ± 400.8 mL (range, 300–2000). The mean transfusion requirement was 1778 ± 798.0 mL (range, 575–4550). The mean length of hospital stay was 8.6 ± 3.7 days (range, 5–22). At the final follow‐up, no loosening of acetabular and femoral components was observed. No osteolysis and heterotopic ossification occurred. The mean Harris hip scores were improved from 55.4 ± 14.3 preoperatively to 91.3 ± 4.2 postoperatively (P < 0.001) In terms of complications, no perioperative deaths were recorded. Deep vein thrombosis occurred in 1 hip, with no pulmonary embolism. Intraoperative femur fracture occurred in 3 hips, nerve injury in 1 hip, and leg length discrepancy in 1 patient. Postoperative dislocation occurred in 5 hips and nonunion in 1 hip. Conclusion: Our data demonstrated that one‐stage bilateral THA for bilateral Crowe type IV DDH is feasible and can effectively restore hip function. [ABSTRACT FROM AUTHOR]

Background: To aim of the present paper was to evaluate the results of halo traction and transarticular screw fixation combined with bone autoplasty in patients with severe atlantoaxial dislocation. Case presentation: This is a retrospective study of severe cases of atlantoaxial dislocation in nine patients (six men and three women) treated with preoperative halo traction and posterior C1–C2 transarticular screw fixation combined with bone autoplasty from June 2006 to June 2011 at the Saint Paul Hospital (Hanoi). The mean age of patients was 37.48 ± 13.753 years (range, 26–50 years). The possibility of fixing dislocation using a halo apparatus was investigated through a series of preoperative halo corrections performed within a span of 1–2 weeks. For transarticular screw fixation, two transarticular screws were used that were positioned according to the Magerl technique. For bone autoplasty, an iliac crest bone graft approximately 3 × 2 cm in size was used. The postoperative assessment of clinical improvement was performed using the neck disability index (NDI), the American Spinal Injury Association (ASIA) impairment scale, and the visual analog scale (VAS) measurement instruments, through the gradation of atlantoaxial dislocation, and via the clivoaxial angle(CAA) index and the space available for cord (SAC) index after 6 months. The image diagnosis demonstrates that all the cases of atlantoaxial dislocations are unstable and correspond to the Fielding and Hawkins type III dislocation. Eight patients underwent complete reduction using the halo fixation device. In one patient, the C1–C2 displacement was manually reduced during surgery. CT scanning revealed that the accuracy of screw placement was 94.4%. The bone fusion rate was 100% after 6 months. Based on the ASIA impairment scale, the preoperative examination of patients revealed grade C injuries in seven patients and grade D injuries in two patients. After surgery, all patients had grade D injuries. Six months after surgery, four patients had moderate self‐reported neck disability (30%–48%) and five patients reported mild disability (10%–28%); that is, the patient perception of the neck problem improved. In the postoperative phase, all patients showed an improvement in VAS pain scores and the SAC score returned to the normal range in all patients. The CAA returned to normal in only seven patients; in the other two patients, the CAA returned to a value that was close to normal (145° and 149°). Conclusion: Through halo traction combined with transarticular screw fixation and bone autoplasty, noticeable postoperative improvements were attained based on the clinical scores for NDI, ASIA, and VAS, as well as SAC and CAA. [ABSTRACT FROM AUTHOR]